Stuck with Nearly $17k in Unfair Medical Debt, What Could He Do?
The hospital didn’t tell him the price. His insurance wouldn’t pay. Then they put him nearly $17k in debt.
By Jason Silverstein
Daniel Hill couldn’t sleep. Every night, he’d wake up at 2am. “My brain was racing,” he said. “I was wide awake.”
To determine if sleep apnea was the cause, Daniel was ordered by his doctor to have a sleep study at JFK Medical Center in Edison, New Jersey.
Daniel asked before he scheduled his study how much it cost. “I was told that it was impossible to give me an accurate price ahead of time, and that I could only find out the cost after my insurance company was billed,” he said.
That was in October 2020 before the Hospital Price Transparency Rule went into effect on January 1, 2021. “Hospitals are required by the Hospital Price Transparency Rule to publicize cost estimate for shoppable services. A hospital would be violating the CMS regulation if it refuses to inform patients the price of a shoppable procedure,” explained Ge Bai, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.
Daniel wasn’t worried, though, because he was told no pre-authorization was needed for his sleep study, which is documented in a handwritten note that we obtained from Hackensack Meridian Health, of which JFK Medical Center is an affiliate. He had faith his insurance would cover it.
“This basically makes me want to never go to a doctor ever again because the cost is unpredictable. What other thing do you buy in life without knowing the cost beforehand?”
It turned out that Daniel needed two sleep studies. The first, on October 3, 2020, confirmed sleep apnea. Daniel was billed $9,181. A second, on December 3, determined the pressure of the CPAP machine to treat it. Daniel was billed another $9,160.
But his insurance company, Salvasen Health, refused to pay. Because of an in-network discount, Daniel’s bill was reduced by $2,751.15. Still, he was stuck with $15,589.85 in medical debt that he had no way to pay.
Since December 2020, Daniel has tried to resolve his debt on his own. He made phone calls. He contacted his insurance company. He wrote letters to the New Jersey Department of Banking and Insurance.
It all seemed so unfair. “This basically makes me want to never go to a doctor ever again because the cost is unpredictable. What other thing do you buy in life without knowing the cost beforehand?” he said.
Daniel decided to do some investigating. To find the fair price for sleep studies in his region, he used HealthcareBluebook.com and FairHealthConsumer.org. Those sites reported the fair prices of sleep studies for Edison, New Jersey, to be $1,300 and $1,482, respectively. JFK Medical Center appeared to have charged him seven times the market rate.
On February 1, 2022, after Hackensack Medical Center sent him a debt collection notice, Daniel mailed them a formal complaint, raising the issue of the price markup. He noted that the in-network discount from his insurance ($2,751.15) would have covered the geographic market rate, freeing him of debt. But he did not receive a response.
When Daniel reached out to a law firm for help, they quoted him $600 for an initial consultation and hourly rates. “I figured I would chew through any potential savings pretty quickly,” he said.
Then, on December 26, 2022, Daniel messaged us, Peste Magazine, via Signal, sharing his story, bills, and documents. He signed a HIPAA waiver authorizing us to access and use a limited amount of his protected health information in the investigation and reporting of this story. At the time he contacted us, his medical debt was $16,963.85.
On January 12, 2023, we emailed Hackensack Meridian Health. In order to report this story thoroughly, we gave them a chance to respond and share their perspective. We also wanted to give them an opportunity to explain their price for sleep studies as well as any facts that we did not have. We emailed these questions:
—why Daniel Hill was charged seven times the fair price in the area for sleep studies,
—whether that continues to be the standard rate for sleep studies at your medical center,
—what justifies the higher price,
—how many other patients may have been charged this amount,
—and why Daniel was not told the price when he inquired with the scheduler before having a procedure Dr. Gupta advised him to undergo.
Benjamin Goldstein, Hackensack’s director of public relations, asked to have until January 19 “to research and respond,” which we granted.
Lo and behold, on January 18, Daniel was able to speak by phone with Robert McCaskill, a customer services collections supervisor with Hackensack. McCaskill said they could bring down Daniel’s balances to “the compassionate care rate” of $908.95 per sleep study. Daniel asked them for a reduced amount of $908 instead, which they granted the next day. The final amount was $905.96.
Meanwhile, even though we provided the signed HIPAA waiver from Daniel, Mike McCauley, vice president of communications at Hackensack, gave this response to our questions:
We cannot discuss details regarding a patient's care, including the cost of services, to protect their confidentiality. By law hospitals and health systems cannot discount medical bills, without a specific reason. However, we do offer a very generous compassionate care program. Our team has reached out to this patient to let him know he is eligible for this compassionate care program, which has reduced his bill significantly.
That claim—“hospitals and health systems cannot discount medical bills, without a specific reason”—struck Daniel as odd. “Seriously, they just did it for me today, they can discount bills whenever they want,” Daniel said.
Daniel seems to be right. “What the hospital meant is that a medical bill can be discounted when there is a reason. Pressure from the bargaining power of an insurers or patients (advocated by themselves or by journalists) is among the reasons a medical bill can be discounted,” explained Bai.
While McCauley commends his employer Hackensack on extending their “very generous compassionate care program,” Daniel does not share McCauley’s admiration. “I sent a formal letter via certified mail that received no response, and called many times to various departments within the hospital looking for assistance with no success,” he said.
As of today, Daniel’s debt is paid, after having been reduced from $16,963.85 to $905.96. “It feels like I can finally move on with my life, and I'll never make the mistake of trusting my health insurance company or a medical organization to do what's right for patients when it comes to billing,” said Daniel.
But what remains unclear is why JFK Medical Center charged so much for a sleep study in the first place, how many others have been charged the same rate, and how many, like Daniel, feel crushed by debt and indifference.
Peste Magazine will continue to investigate. If you or someone you know was charged what you believe was an excessive price for sleep studies at JFK Medical Center or any of the Hackensack Meridian Health affiliates, please contact us via secure messaging at 857-242-0630.
Peste Magazine is a nonprofit corporation. We will never charge. We are here to attempt to erase medical debt and any information obtained will be used for that purpose. We demand debt forgiveness. If you have any questions, please contact our office.
Jason Silverstein is the editor-in-chief of Peste Magazine.