Minor Bike Accident Leads To $19,000 Medical Bill And A Legal Fight : Shots - Health News It was a surprise even for a family of lawyers. A process called "subrogation" began with a Nevada family's health insurer denying their claim for an ER visit after their 9-year-old fell off his bike.
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A Kid, A Minor Bike Accident And A $19,000 Medical Bill

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A Kid, A Minor Bike Accident And A $19,000 Medical Bill

A Kid, A Minor Bike Accident And A $19,000 Medical Bill

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MARY LOUISE KELLY, HOST:

Every month, NPR and Kaiser Health News take a close look at medical bills that you send us. Well, today we're going to hear about a particular kind of bill that can be alarming to receive. It involves lawyers. Dr. Elisabeth Rosenthal is here to break it down for us. She's the editor-in-chief of Kaiser Health News.

Hey there, Elisabeth.

ELISABETH ROSENTHAL, BYLINE: Hi.

KELLY: So a medical bill and lawyers - I feel my blood pressure going up already.

(LAUGHTER)

KELLY: Tell us what's going on here.

ROSENTHAL: Well, this one involves what seems to be a growing problem - different types of insurers arguing about which one should cover your medical costs. And of course, the patient is caught in the middle. If you've been injured in a car crash or your kid has broken an arm, requiring a trip to the ER, you might just get a legal document in the mail asking for more information before your health insurance will pay the bill.

KELLY: All right. I'm intrigued but already stressed out because you're in a stressful medical situation, and then you're getting these, you know, letters from lawyers asking you to fill out forms.

ROSENTHAL: That's right - a yikes moment. Adam Woodrum, who lives in Carson City, Nev., got one of those letters concerning his 9-year-old son. But he and his wife are both lawyers, and so they knew something was up.

KELLY: All right. So let's - we're going to hear what happened to Adam Woodrum and his son. We're going to get that story from Dan Weissmann of the podcast "An Arm And A Leg." Elisabeth Rosenthal, stay with us. Let's listen in.

DAN WEISSMANN, BYLINE: One Sunday last July, Adam Woodrum and his wife and their two kids took off on a bike ride around Carson City, Nev., where they live.

ADAM WOODRUM: I'd mapped out kind of a 10-mile route, and we were just going to kind of make a loop of the city.

WEISSMANN: But a couple miles in, their 9-year-old son hit a snag.

WOODRUM: We were navigating through some big tree planters, and his handlebar caught. And it just - almost instantaneously, he was on the ground crying, bleeding. And I'm no doctor, but, you know, right away, you can tell that this is a stiches situation.

WEISSMANN: At the ER, they actually had to put the poor kid under.

WOODRUM: He was cut in sort of a personal area. Let's just say that.

WEISSMANN: A few weeks later, Adam's insurance company writes him. The total charges are $19,000, and, they say, you are on the hook for all of it.

WOODRUM: It's just ridiculous. It's a ridiculous place to start from.

WEISSMANN: And in the fine print, it said, we're denying this claim, but we could reconsider. Quote, "You will receive an accident questionnaire in a separate mailing," or you may go to website blah, blah, blah, or call this 800 number or email subrogationlnlattorneys.com with any additional questions.

WOODRUM: And it's clear as mud, right?

WEISSMANN: But to Adam, it makes sense. The insurance company is trying to see if there's a way out of paying this bill. See, Adam's a personal injury lawyer. Accidents, insurance claims - this is his everyday professional world.

WOODRUM: I mean, this LNL Attorneys - I work with them probably once or twice a month. I have their email addresses. I mean, I know who they are.

WEISSMANN: And he knows what subrogation is. For the rest of us, it's sub, like substitution. The insurance company thinks maybe somebody else should be on the hook for this bill and sub out for them in paying 'cause there's been an accident.

WOODRUM: It's basically a contractual right.

WEISSMANN: Like, if you were rear-ended, the other driver or their insurance should be responsible. So the health insurance company's trying to get Adam on the record. What happened? Is there somebody else maybe on the hook? Please sign here. Health insurance companies hire law firms like this LNL outfit in Ohio to make sure you jump through the hoops. The law firm sends out their own letter with the questionnaire. Adam kept an eye out for it, filled it out right away.

WOODRUM: I knew exactly what to expect, and I knew exactly how to handle it because I know how to operate the system. But I, from experience, know that other people do not know how to operate the system.

WEISSMANN: Other people like his clients.

WOODRUM: People just simply have no clue what subrogation is or what that - you get a letter from a lawyer in Ohio that says, hey, we need you to come to our website and fill out some paperwork or we're not going to release your claims to be paid. And you go, well, nuts to you. I don't have any idea who you are or what this is.

WEISSMANN: So people ignore those letters, and their insurance doesn't pay the medical bills. And they end up in collections. He thought sending in his bill would be a good way to give more of us a heads-up.

For NPR News, I'm Dan Weissmann.

KELLY: Oh, wow. What a story.

ROSENTHAL: (Laughter) Yes.

KELLY: All right. Elisabeth Rosenthal is still with us, listening in. First, how is Adam's son? Is he OK?

ROSENTHAL: Yeah, he's great. He's back on his bike.

KELLY: That is the good news. What about, though, this bill - $19,000? What happened next?

ROSENTHAL: Well, they knew how to handle it, and insurance paid, so they only owed their normal deductible. But remember, they understood the game that was going on here.

KELLY: Yeah. The dad is a personal injury lawyer married to another lawyer. I'm sure that helps. What should the rest of us do?

ROSENTHAL: For the rest of us, it's important to learn a lesson from them. While the insurers are duking it out over who will pay, the hospitals and doctors are often sending patients bills and threatening them and maybe even threatening collections.

So I think for patients, the first is our perennial lesson - don't just pay the bill. Take action. Fill out the forms they send you. Be clear about what happened. This was just a kid who fell off a bike. And let the hospital and doctors know why you're not paying the bill so they won't go after you.

Also, if you have to fill out your own claims forms, beware of that little box we often see that says, was this caused by an accident? What that means to an insurer may be, hey, maybe we don't have to pay, which is not what you're thinking when you check that box.

KELLY: Well, I'm glad there was a happy ending to this particular story and wise words for the rest of us. Elisabeth Rosenthal, thank you for being here.

ROSENTHAL: Thanks for having me again.

KELLY: And if you have a perplexing bill that you would like us to take a look at, go to NPR's Shots blog and tell us about it.

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