Bamboozled June 22, 2017: Would you keep $14K from your insurance company? See why this man won’t

Most people, if their medical bills are covered by insurance, won’t question the charges.

If nothing comes out of their pockets, they figure, who cares?

But unnecessary and excessive medical bills are a big part of why we all pay more for health insurance, and for health care in general.

Back to Jim Quinn.

He fell off his bicycle in August 2016 and ended up in the emergency room at St. Joseph’s Regional Medical Center in Paterson.

He said he saw two residents, who took his X-rays to an attending physician, and they gave him a splint.

Quinn said he walked out with a broken wrist and a broken clavicle , and a bill for nearly $30,000.

The charges included, per the benefits statements from his insurer, UnitedHealthcare (UHC), a hospital charge of $7,349, two ambulance charges totaling $3,745, and charges of $17,333 for the orthopedist.

The $17,333 charge was listed as “surgery.”

But, Quinn said, he never had surgery. There was no cutting. Just a splint.

“Since I did not have surgery, I expected that this was a billing error,” Quinn said at the time. “Wrong.”

Quinn asked his insurance company and the orthopedic practice how it could charge $17,333 when Quinn never saw the orthopedist, and when he certainly didn’t have surgery.

Both said the charge was correct.

“They defended the payment as ‘usual, customary and reasonable,'” he said. “They were not persuaded that $17,000 for looking at X-rays and concurring with the residents’ view of the diagnosis was an unreasonable charge.”

UHC sent him a check for $17,333 to pay the orthopedist.

But, Quinn asked, given that no one operated on him, how could the bill say “surgery?”

While Quinn appealed the decision with his insurance company, he paid $3,000 from the insurance money to stop collection threats from the orthopedist. The rest he kept in a separate account.

UHC eventually said his complaint didn’t qualify for the appeals process.

“I think the charges are outrageous and shed light on the dismal state of escalating medical costs,” Quinn said, and that’s why he contacted Bamboozled.

We learned “surgery” doesn’t necessarily mean cutting, but is often used a description for an insurance code for other kinds of care, including casting or splinting a broken bone.

After Quinn’s multiple complaints, the orthopedist agreed in writing to accept the $3,000 Quinn already paid for the services he received.

The practice said Quinn could return the balance of the money to the insurance company or he could pay it to the orthopedist, documents show.

Then it got more confusing.

Quinn received a new notice from UHC, saying the recommended charge for the orthopedist’s services should be $2,316.02.

After that, he received another bill from the orthopedist showing a balance of $14,333.

What ever happened to the promise to accept the $3,000 Quinn already paid?

Quinn just got the answer earlier this week.

He received a new note from the orthopedist, confirming it would accept the $3,000 already paid.

So Quinn wrote to UHC on June 19, asking what he should do with the remaining $14,333 the insurance company has given him for the original orthopedist bill.

To date, he hasn’t received a response, and UHC didn’t respond to our inquiries in time for publication.

Quinn has no intention to keep the money.

“It’s not my money,” he said. “It was from a ridiculous amount charge for the care that I got — much more than what should have been paid.”

Quinn said it’s hard for a layman to understand medical coding and what charges are for, and medical costs are out of control because of a lack of transparency.

“There’s a prevailing attitude that your insurance is going to cover it, but you wouldn’t do that for any other charge,” he said. “You’d investigate and make sure you knew what you were paying for.”

Quinn said he hopes his case will raise awareness so others will pay attention to their bills.

We hope so, too.

Cheers to Quinn. He’s our hero of the day, yet again.