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ER visit delivers big bill for some

While new hospital contractor negotiates with health insurance companies, patients given unresolved tab

Some patients received a bill way in excess of their expected copay for visits to the Maui Memorial Medical Center. Officials with the hospital, contracted emergency physicians group and insurers say the error came during monthslong negotiations between the insurers and the physicians group. -- The Maui News / MATTHEW THAYER photo

After surviving a 106-degree fever, two emergency room trips, gallbladder surgery, pneumonia and sepsis, Farray Rodgers wasn’t in any mood to hear from her insurance carrier that the Maui Memorial Medical Center emergency room was a “nonparticipating” provider and that her out-of-pocket ER cost was more than $5,000.

Her insurer, Hawaii Medical Assurance Association (HMAA), sent her reimbursement checks for a fraction of the charges and told her to take them to the emergency room physician group, which should lower her bills and the amount she had to cover. In one instance, she received a reimbursement check of $175 from HMAA for a $2,441 emergency room charge.

Rodgers, a 36-year-old single parent from Waikapu, said she had no problem with bills for her other services, such as for her hospital stay and surgery.

As she continues her recovery and continues to deal with pain in her lung from the sepsis, she still is waiting to see what her emergency room bill finally will be.

Rodgers’ problem stems from a new emergency room contractor for Maui Memorial and its negotiating of contracts with insurance companies, including HMAA, say representatives of Maui Health System, which runs Maui Memorial; Maui Memorial Emergency Medical Associates, which received the emergency room physicians contract; and insurance companies.

Dr. Lee Weiss, medical director and chairman of the Department of Emergency Medicine at Maui Memorial Medical Center and part of the contracted emergency physicians group, said a handful of patients may have been billed incorrectly during negotiations between the physicians group and insurers. This photo was taken Thursday outside the Maui Memorial Medical Center Emergency Room. -- The Maui News / MATTHEW THAYER photo

The new emergency room physicians group, whose parent company is Emergent Medical Associates, came on board in July. Since then, insurance companies have been negotiating contracts with them.

Yvonne Biegel, director of strategic communications for Maui Health System, said she has been told by the ER physician group that four or five patients received incorrectly high bills while insurance companies were negotiating their contracts.

Insurers HMAA and UHA confirmed that incorrect billings may have occurred during contract talks.

HMAA and UHA recently finalized agreements with the emergency room physicians group. Hawaii Medical Services Association, the state’s largest insurer, reached an agreement earlier, said Dr. Lee Weiss, medical director and chairman of the Department of Emergency Medicine at Maui Memorial Medical Center and part of the emergency physicians group.

All contracts have been finalized, with the exception of Kaiser Permanente, the parent company of Maui Health System, he said. That contract is expected to be completed in the next couple of weeks and Kaiser assures patients that they will not be put in Rodgers’ situation.

A balance bill

If patients received what he called “a balance bill,” as in Rodgers’ case, it would be “a huge error,” said Weiss, who also is chief clinical operations officer for Emergent Medical Associates. A balance bill is the difference between the provider’s charge and the amount an insurer is willing to pay — with the patients picking up the difference as well as their copay.

After becoming aware of the incorrect bills, his group informed its billing company, Weiss said. He accepted blame for the incorrect billing, saying “in this facility, the buck stops with me.”

“We never put a patient in the middle,” he said, noting that he’s been a patient in an emergency room and can empathize.

But Rodgers did feel she was in the middle. She said the balance bill should be an insurance-provider issue, not a patient issue. Initially, she did not submit the reimbursement checks from HMAA, concerned that her insurer would ignore her full medical claims, but eventually gave them to the emergency physicians group.

“I am happy to pay my deductible, keep my excellent credit, however not deal with the claims for HMAA,” said Rodgers. “We have a federal right to go to the ER within a 100-mile radius of where we live.”

Patients are not going to be referred to creditors and will not be penalized for issues surrounding the billing as contract negotiations were ongoing, Weiss said.

Despite the issues, Weiss and Biegel emphasized that emergency room services continued seamlessly.

“I want to be clear that there has been no disruption of care of our patients and this community,” said Biegel. “That’s our mission here. We are providing our community with quality and compassionate care and that includes emergency care.

“We don’t refuse anybody; we treat everyone that comes through the door.”

Weiss said federal law, the Emergency Medical Treatment and Labor Act, requires emergency rooms to treat patients regardless of their insurance status. He added that emergency room physicians don’t know whether patients have insurance or what type of coverage they have; their first mission is to care for the patient.

Biegel said it is common practice for a hospital to contract out emergency room physicians. It occurred before Maui Health System assumed operations of Maui Memorial, Lanai Community and Kula hospitals from quasi-public Hawaii Health Systems Corp. on July 1, 2017.

Forging a deal

Negotiations between a contractor and insurance providers can take weeks or months, said Weiss. Contracts with UHA and HMAA took five and six months, respectively, to finalize.

Generally, contracts with major insurance companies in Hawaii are for a minimum of one to two years, he said. They automatically renew unless one of the parties makes a request to address any issues.

Maui Memorial is Emergent Medical Associates’ first Hawaii hospital. Emergent is a large group that practices all over Southern California and places an emphasis on quality measurements, such as how quickly doctors attend to patients and an evaluation of the patient’s experience, which are included in contacts.

HMAA and UHA both said that some of their emergency room patients may have been billed or paid more than they needed to.

Rodgers’ insurance carrier, HMAA, said in a written statement that it will be adjudicating claims with Maui Memorial Emergency Medical Associates for members affected by the lack of a contract since July 1.

HMAA will retroactively reimburse the emergency room physicians group for unpaid amounts per the new agreement and will work with the group to address and reimburse any amounts paid by members above the plan’s copayments or deductibles, the statement said.

“We apologize for any inconvenience this contract negotiation may have caused our members,” the statement said. “HMAA believes their efforts to bring to the forefront the ongoing challenges within the health care industry begins a critical dialogue about the true costs of health care.”

HMAA did not respond to specific issues relating to Rodgers’ case because of privacy reasons.

UHA had billing issues during contract negotiations as well. UHA and the emergency physicians group reached an agreement in December, said Howard Lee, president and CEO of UHA. The contract covers emergency room physician services from July 7.

Lee said that UHA’s goal during negotiations with the physicians group “was to minimize out-of-pocket expenses for UHA members (eliminating bills) in excess of their copay.”

When negotiations were ongoing throughout the summer and fall, UHA kept in communication with its members and notified them once an agreement was reached. It also notified all of its Maui County members in July about the new emergency room provider.

The notice was sent to members via members’ employer groups and was posted on UHA’s website, Lee said.

UHA consistently advised UHA members to contact them if they received bills in excess of their copays, he said.

“Throughout this process, UHA has maintained contact with MMEMA regarding its erroneous billing of UHA members who received its ER services, which was unfortunate,” Lee said.

He added that emergency room coverage for UHA members never ceased even if they were in negotiations.

If members received bills for out-of-network ER physician services, Lee said, they were told that the bills were sent in error and to wait until they received an updated invoice reflecting UHA’s payment and any applicable copayment.

Any UHA members who believe they are due a refund on payments for an erroneous emergency room bill should contact UHA customer service at (800) 458-4600.

As for Kaiser insurance patients, spokeswoman Laura Lott said the emergency room physician’s group has agreed not to send Kaiser insurance patients balance bills during negotiations.

If Kaiser insurance patients did receive those bills, they should not pay them, Lott said. But if patients already have paid, Lott said the emergency room physicians group would refund anything more than the patient’s copayment/coinsurance.

Biegel said that Maui Memorial Medical Center has a financial assistance program for patients who need help. For information, patients can call (808) 868-5281,

* Melissa Tanji can be reached at mtanji@mauinews.com.

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