Her son's burn injury led to an ER billing debacle and a fight with collections : Shots - Health News A Florida woman tried to dispute an emergency room bill, but the hospital and collection agency refused to talk to her — because it was her child's name on the bill, not hers.

Pay up, kid? An ER's error sends a 4-year-old to collections

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It's time for our Medical Bill of the Month, which this month was sent to a preschooler. Dr. Elisabeth Rosenthal is editor-in-chief of our partner, Kaiser Health News. Welcome, Dr. Rosenthal.

ELISABETH ROSENTHAL: Oh, thanks for having me again.

SUMMERS: All right. So tell us who we're meeting today.

ROSENTHAL: Well, today we're meeting Sara McLin from Florida, who did what we urge consumers to do. When she got an emergency room bill that was obviously wrong, she tried to dispute it. But because the bill was in her 4-year-old's name, not hers, first the hospital and then a collection agency refused to talk to her. They said they had to speak to the kid.

SUMMERS: Huh. OK. So basically, the hospital wanted her kid to pay up. All right. Reporter Sojourner Ahebee has Sara's story. Let's listen.

SOJOURNER AHEBEE: When 4-year-old Keeling burned his hand on a hot stove, Sara rushed her son to the emergency room.

SARA MCLIN: And, of course, he was inconsolable. I mean, he was absolutely screaming.

AHEBEE: Even in the midst of all that, Sara thought she was making a solid financial decision for her family. The ER just north of Tampa was in-network for their health plan. At the ER, Sara says a physician told her Keeling needed to go to a specialist burn care center.

MCLIN: But, I mean, I was just thinking, oh, my gosh, you know, it's a third-degree burn. What's going to happen? What's he going to need to have done?

AHEBEE: Sara is a dentist. She understands the ins and outs of the health care system. But with her 4-year-old in pain, the last thing on her mind was if there'd be a bill. Here's what the doctor said.

MCLIN: I don't remember exactly how she phrased it, but something along the lines of, well, we won't even call this a visit because we can't do anything.

AHEBEE: At the second hospital, little Keeling got the care he needed. He was bandaged up, went home, and he's just fine now. Then the bills came, and here's where the story gets strange. One bill was addressed to Sara's preschool-aged son. It said the 4-year-old was the person responsible for the bill. Plus, the hospital listed Keeling as uninsured and unemployed. Sara says, when she called the hospital that operates the ER, she hit a wall because her name was not on the bill.

MCLIN: Literally, I had a couple people say, OK, I literally cannot talk to you about this. I could be in trouble legally for speaking with you. And, I mean, it just blew my mind. It was the craziest thing. And I said, but I - he's a minor. He's 4. What do you mean you can't talk to me?

AHEBEE: This went on for months. Sara got more frustrated. Then, in January, Sara received a letter from a collection agency called Medicredit. The letter said that her 4-year-old owed about $130.

MCLIN: I just started getting collection notices.

AHEBEE: Sara tried calling the collection agency, but says representatives refused to speak to her, noting yet again that the bill was not in Sara's name. Finally, in March, Sara says she got a call from a customer service representative connected to HCA Healthcare, but that's only after a reporter reached out to HCA to inquire about the collections bill in Keeling's name.

MCLIN: She wanted to assure me that nothing had ever been sent to credit monitoring. Now, I - does that even exist for a 4-year-old - well, now 5-year-old? I doubt it.

AHEBEE: An HCA marketing director followed up to say the health system had reached out to Sara to apologize to her for the inconvenience and that there was a zero balance on the account. In the end, Sara says, it wasn't even about the money. The most vexing part was all the time she lost.

MCLIN: And thankfully, I'm really stubborn, and I was really irritated. And so I decided to keep pushing for months and months. Most people, I think, would give up.

AHEBEE: For NPR News, I'm Sojourner Ahebee.

SUMMERS: We are back with Dr. Elisabeth Rosenthal. OK. So to me, this feels like there should have been an easy fix here. But tell us, why was there not one?

ROSENTHAL: Well, I think because, these days, much of medical billing is completely automated. So it's gotten easier for mistakes like this to happen, right? A machine might not realize that, hey, this isn't right - billing a preschooler. This doesn't make any sense. But, you know, when Sara's talked to real people at the other end of the phone, someone could have looked at Keeling's date of birth or the ER record where the doctor noted his age and corrected the error. But unfortunately, department reps often seem to follow the machine rather than common sense.

SUMMERS: OK, so I wonder - can a billing mistake like this hurt a kid down the road? I mean, I'm thinking of his credit or perhaps even his ability to get a student loan in the future.

ROSENTHAL: Well, that's certainly a concern. I mean, in Keeling's situation, it wasn't sent to a credit reporting agency, but this kind of stuff could happen. So when you're getting medical care for your child, check that you - the parent or guardian - is listed as the financially responsible party. And if an error does go all the way to collections, make double sure that the agency removes any record of the debt to protect the child's financial future.

SUMMERS: And so what about when bill collectors start calling? Do people just give up and pay the bill at that point?

ROSENTHAL: Well, too many do, but they shouldn't. It's not, like, game over, you lose, once a bill goes to collections. Consumers do have rights, but it's awful how much effort it takes to assert them. You have to document every interaction, try to get promises in writing. And if it's legal where you live, I'd suggest even recording your phone calls, but it's a lot to ask of patients.

SUMMERS: Certainly. That's good advice, though, from Dr. Elisabeth Rosenthal. Thank you, as always.

ROSENTHAL: Thank you.

SUMMERS: If you have a confusing medical bill that you want us to review, please go to NPR's Shots blog and tell us all about it.


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