Mistaken identity leads to big hospital bill mix-up : Shots - Health News A health system charged a woman for a shoulder replacement she didn't need and hadn't received. She didn't receive the care, but she did receive the bill — and some medical records of a stranger.

The case of the two Grace Elliotts: a medical bill mystery

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It's time once again for the Bill of the Month, when we look into ridiculous medical bills and what we can do about them. Dr. Elisabeth Rosenthal is our guide, the editor-in-chief of our partner, Kaiser Health News. Welcome back.

ELISABETH ROSENTHAL: Thanks for having me.

INSKEEP: Whose case do you have this time?

ROSENTHAL: Well, this time we have a billing error that resulted from two patients caught up in a case of mistaken identity. You see, both were named Grace Elliott. But one Grace Elliott is a young woman, a preschool teacher in California. The other is a retiree in Florida. This obvious clerical error should have been easy to fix, but instead it dragged on for months and months and months. And eventually the younger Grace Elliott got handed over to a collections agency for a shoulder surgery that she didn't have.

INSKEEP: That does not sound fun. So let's hear the story from reporter Stephanie O'Neill, who spoke with Grace Elliott and also spoke with Grace Elliott.

STEPHANIE O'NEILL: Thirty-one-year-old Grace Elliott of San Francisco was confused this past January when she opened a hospital bill bearing her name for a shoulder replacement she'd never received from a Florida hospital she hadn't visited for nearly a decade, the whole thing causing her to wonder...

GRACE E ELLIOTT: What happened? What's wrong here? I knew it wasn't my bill.

O'NEILL: Turns out the outstanding bill was for a different woman named, coincidentally...

GRACE A ELLIOTT: Grace Elliott. I'm 81, and I live in Venice, Fla.

O'NEILL: That's right - same name, very different Grace, one who's 50 years older and lives across the country in Venice, Fla. That's the same town that younger Grace lived in with her parents for about a nanosecond a decade ago. During that time, she got sick, went to the local hospital, got a bill in the mail and paid it in full. Grace then moved to San Francisco and never visited the Florida hospital again. So when the hospital sent a bill for somebody else's shoulder surgery to her family home in Venice, Fla., Grace wasn't concerned.

E ELLIOTT: I thought there must be an error, like, a really simple error that should easily be fixed here.

O'NEILL: But her attempts to fix it went nowhere, despite innumerable phone calls. Eventually, the hospital compliance department got involved, and Grace thought they would finally resolve everything.

E ELLIOTT: And then I got more bills. The compliance department seemed to think, oh, we just put down the wrong birthday. Like, this is the right person, but the birthday is wrong.

O'NEILL: For months, the cycle spun - Grace calling, Grace explaining the hospital's mistake, and the hospital doing nothing.

E ELLIOTT: After contacting the hospital again and again and again, that's when I started to worry, is this affecting my credit score?

O'NEILL: That answer came when a debt collector demanded she pay for the shoulder surgery or suffer the credit consequences. Younger Grace gave them photo proof that she wasn't 81 years old. The collection agency's response - to send her a trove of private health information and personal details belonging to older Grace.

E ELLIOTT: A full picture of her photo ID, her driver's license, which included her birthday, her address. I could see why she was at the hospital, which I should have never been able to see.

O'NEILL: With that information, younger Grace did something she says the hospital should have done. She found the correct Grace Elliott. So she sent her a text.

A ELLIOTT: When I got the text, I read it, but I did not answer her.

O'NEILL: Because she thought it was a scam. Undaunted, younger Grace kept up her efforts, and finally the two Graces made contact. Eighty-one-year-old Grace Elliott of Venice, Fla., says she's thankful to 31-year-old Grace Elliott of San Francisco for working so hard to piece together this puzzle of mistaken identity billing, which the hospital says it believes was an isolated incident. Meanwhile, an executive at the collections agency has responded by saying it, quote, "follows all state and federal rules and regulations," end-quote.

For NPR News, I'm Stephanie O'Neill.

INSKEEP: So that's our Bill of the Month. And let's finish the discussion with Dr. Elisabeth Rosenthal because, as you just heard, there was a problem, but the health system didn't exactly fix it right away until a reporter started calling and asking questions. What happened then?

ROSENTHAL: Well, even then, last we checked, the collections agency still hadn't told the younger Grace that she's off the hook for the bill.

INSKEEP: So this story is not quite done at all. Well, how do people avoid getting into this situation to begin with?

ROSENTHAL: Well, hospitals are supposed to have safeguards in place, like asking for a photo ID. But a name mix-up is pretty common. You know, these two Grace Elliotts had different middle initials, but this one resulted in crazy, crazy billing. And other kinds of medical mix-up can also happen, like the electronic record saying you have a medical condition or an allergy you don't have. What patients can do to try and nip these problems in the bud is checking your patient portal carefully. So many people never even look at that.

INSKEEP: And there often is that step where they say, check all your information. Review your information. Make sure it's correct. That's a thing to really do.

ROSENTHAL: It is because there - you know, there are many upsides to medical records, but one downside to electronic records is that once an error is there, it basically exists in perpetuity. And that was part of the problem with Grace Elliott. When someone sees something written down on a medical record, they believe that more than they believe a person saying, no, no, no, no, no, I'm not that Grace Elliott.

INSKEEP: Well, what can the person do in that situation then?

ROSENTHAL: You do what Grace Elliott the younger did. You challenge errors forcefully with documentation as she did. Take the names of the people you're speaking to, and try and stop it before it gets sent to a collection agency because once it's at a collection agency, their goal is to collect a bill, not to say was this medically right or wrong? And I always say if the billing problem persists, go to your state Consumer Protection Bureau or Better Business Board. That will scare people.

INSKEEP: That will get them an incentive to listen to you, I suppose.

ROSENTHAL: Yeah, or Bill of the Month.

INSKEEP: Or that. Go to the bill - or go to the Bill of the Month. Dr. Elisabeth Rosenthal closing out a year of outrageous medical bills and unconscionable billing practices. There's a word we don't get to use that often on the radio - unconscionable. And we will resume in January. Thanks so much.

ROSENTHAL: Thanks for having me.


INSKEEP: If you have a medical bill that just seems wrong and you can't get to the bottom of it, go to NPR's Shots blog. Tell us all about it.

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