{"id":2164,"date":"2023-12-19T16:42:43","date_gmt":"2023-12-19T16:42:43","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=2164"},"modified":"2023-12-19T16:43:39","modified_gmt":"2023-12-19T16:43:39","slug":"when-a-quick-telehealth-visit-yields-multiple-surprises-beyond-a-big-bill","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=2164","title":{"rendered":"When a Quick Telehealth Visit Yields Multiple Surprises Beyond a Big Bill"},"content":{"rendered":"<div>\n<p>In September 2022, Elyse Greenblatt of Queens returned home from a trip to Rwanda with a rather unwelcome-back gift: persistent congestion.<\/p>\n<p>She felt a pain in her sinuses and sought a quick resolution.<\/p>\n<p>Covid-19 couldn\u2019t be ruled out, so rather than risk passing on an unknown infection to others in a waiting room, the New Yorker booked a telehealth visit through her usual health system, Mount Sinai \u2014 a perennial on best-hospitals lists.<\/p>\n<p>That proved an expensive decision. She remembers the visit as taking barely any time. The doctor decided it was likely a sinus infection, not covid, and prescribed her fluticasone, a nasal spray that relieves congestion, and an antibiotic, Keflex. (The Centers for Disease Control and Prevention <a href=\"https:\/\/www.cdc.gov\/antibiotic-use\/sinus-infection.html\">says antibiotics<\/a> \u201care not needed for many sinus infections, but your doctor can decide if you need\u201d one.)<\/p>\n<p>Then the bill came.<\/p>\n<p><strong>The Patient:<\/strong> Elyse Greenblatt, now 38, had insurance coverage through Empire BlueCross BlueShield, a New York-based insurer.<\/p>\n<p><strong>Medical Services:<\/strong> A telehealth urgent care visit through Mount Sinai\u2019s personal record app. Greenblatt was connected with an urgent care doctor through the luck of the draw. She was diagnosed with sinusitis, prescribed an antibiotic and Flonase, and told to come back if there was no improvement.<\/p>\n<p>All this meant a big bill. The insurer said the telehealth visit was deemed an out-of-network service \u2014 a charge Greenblatt said the digital service didn\u2019t do a great job of warning her about. It came as a surprise. \u201cIn my mind, if all my doctors are \u2018in-insurance,\u2019 why would they pair me with someone who was \u2018out-of-insurance\u2019?\u201d she asked. And the hospital system tried its best to make contesting the charge difficult, she said.<\/p>\n<p><strong>Service Provider:<\/strong> The doctor was affiliated with Mount Sinai\u2019s health system, though where the bill came from was unclear: Was it from one of the system\u2019s hospitals or another unit?<\/p>\n<p><strong>Total Bill:<\/strong> $660 for what was billed as a 45- to 59-minute visit. The insurer paid nothing, ruling it out of network.<\/p>\n<figure class=\"wp-block-embed is-type-rich is-provider-documentcloud wp-block-embed-documentcloud\">\n<p>\n<iframe loading=\"lazy\" title=\"BOTM_December-2023 (Hosted by DocumentCloud)\" src=\"https:\/\/embed.documentcloud.org\/documents\/24199359-botm_december-2023\/?embed=1\" width=\"570\" height=\"750\" style=\"border: 1px solid #aaa;\" sandbox=\"allow-scripts allow-same-origin allow-popups allow-forms allow-popups-to-escape-sandbox\"><\/iframe>\n<\/p>\n<\/figure>\n<p><strong>What Gives:<\/strong> The bill was puzzling on multiple levels. Most notably: How could this be an out-of-network service? Generally, urgent care visits delivered via video are a competitive part of the health care economy, and they\u2019re not typically terribly expensive.<\/p>\n<p>Mount Sinai\u2019s telehealth booking process is at pains to assure bookers they\u2019re getting a low price. After receiving the bill, Greenblatt went back to the app to recreate her steps \u2014 and she took a screenshot of one particular part of the app: the details. She got an estimated wait time of 10 minutes, for a cost of $60. \u201cCost may be less based on insurance,\u201d the app said; this information, Mount Sinai spokesperson Lucia Lee said, is \u201cfor the patient\u2019s benefit,\u201d and the \u201ccost may differ depending on the patient\u2019s insurance.\u201d<\/p>\n<p>A $60 fee would be in line with, if not a bit cheaper than, many other telehealth services. Doctor on Demand, for example, <a href=\"https:\/\/doctorondemand.com\/about-us\/cost\/\">offers visits<\/a> from a clinician for $79 for a 15-minute visit, assuming the customer\u2019s insurance doesn\u2019t cover it. Amazon\u2019s new clinic service, offering telehealth care for a wide range of conditions, advertises that <a href=\"https:\/\/clinic.amazon.com\/Sinus-infection-sinusitis-treatment\/dp\/B0BVCR825C?ref_=sf_conditions_sinusitis\">charges start at $30<\/a> for a sinus infection.<\/p>\n<p>The Health Care Cost Institute, an organization that analyzes health care claims data, told KFF Health News its data shows an urgent care telehealth visit runs, on average, $120 in total costs \u2014 but only $14 in out-of-pocket charges.<\/p>\n<div class=\"wp-block block--newsletter  \" data-type=\"kaiser-health-news\/newsletter\" data-align=\"center\" style=\"\">\n<h4 class=\"newsletter__title\">\n\t\t<a href=\"https:\/\/kffhealthnews.org\/email\/\"><br \/>\n\t\t\tEmail Sign-Up\t\t<\/a><br \/>\n\t<\/h4>\n<p class=\"newsletter__description\">\n\t\tSubscribe to KFF Health News&#8217; free Morning Briefing.\t<\/p>\n<\/div>\n<p>So how did this visit end up costing astronomically so much more than the average? After all, one of the selling points of telemedicine is not only convenience but cost savings.<\/p>\n<p>First, there was the length of the visit. The doctor\u2019s bill described it as moderately lengthy. But Greenblatt recalled the visit as simple and straightforward; she described her symptoms and got an antibiotic prescription \u2014 not a moderately complex visit requiring the better part of an hour to resolve.<\/p>\n<p>The choice of description is a somewhat wonky part of health care billing that plays a big part in how expensive care can get. The more complex the case, and the longer it takes to diagnose and treat, the more providers can charge patients and insurers.<\/p>\n<p>Greenblatt\u2019s doctor billed her at a moderate level of care \u2014 curious, given her memory of the visit as quick, almost perfunctory. \u201cI think it was five minutes,\u201d she recalled. \u201cI said it was a sinus infection; she told me I was right. \u2018Take some meds, you\u2019ll be fine.\u2019\u201d<\/p>\n<p>Ishani Ganguli, a doctor at Brigham and Women\u2019s Hospital in Boston who studies telehealth, said she didn\u2019t know the exact circumstances of care but was \u201ca bit surprised that it was not billed at a lower level\u201d if it was indeed a quick visit.<\/p>\n<p>That leaves the out-of-network aspect of the bill, allowing the insurer to pay nothing for the care. (Stephanie DuBois, a spokesperson for Empire BlueCross BlueShield, Greenblatt\u2019s insurer, said the payer covers virtual visits through two services, or through in-network doctors. The Mount Sinai doctor fit neither criteria.) Still, why did Mount Sinai, Greenblatt\u2019s usual health care system, assign her an out-of-network doctor?<\/p>\n<p>\u201cIf one gets their care from the Mount Sinai system and the care is within network, I don\u2019t think it is reasonable for the patients to expect or understand that one of the Mount Sinai clinicians is suddenly going to be out of network,\u201d said Ateev Mehrotra, a hospitalist and telehealth researcher at Beth Israel Deaconess Medical Center.<\/p>\n<p>It struck the doctors specializing in telehealth research whom KFF Health News consulted as an unusual situation, especially since the doctor who provided the care was employed by the prestigious health system.<\/p>\n<p>The doctor in question may have been in network for no insurers whatsoever: A review of the doctor\u2019s Mount Sinai profile page \u2014 archived in November 2022 \u2014 does not list any accepted insurance. (That\u2019s in contrast to other doctors in the system.)<\/p>\n<p>Lee, Mount Sinai\u2019s spokesperson, said the doctor did take at least some insurance. When asked about the doctor\u2019s webpage not showing any accepted plans, she responded the site \u201cinstructs patients to contact her office for the most up-to-date information.\u201d<\/p>\n<figure class=\"wp-block-image alignwide size-full\"><figcaption class=\"wp-element-caption\">Greenblatt was surprised to learn that the doctor she saw during a telehealth appointment through her usual health system was out of its network. A health system staffer later told her she\u2019d signed a form consenting to the out-of-network charge \u2014 but Greenblatt said she didn\u2019t recall signing it.<span class=\"photo-credit\">(Shelby Knowles for KFF Health News)<\/span><\/figcaption><\/figure>\n<p>Attempting to solve this billing puzzle turned into a major league headache for Greenblatt. Deepening the mystery: After calling Mount Sinai\u2019s billing department, she was told the case had been routed to disputes and marked as \u201curgent.\u201d<\/p>\n<p>But the doctor\u2019s office would seemingly not respond. \u201cIn most other professions, you can\u2019t just ignore a message for a year,\u201d she observed.<\/p>\n<p>The bill would disappear on her patient portal, then come back again. Another call revealed a new twist: She was told by a staffer that she\u2019d signed a form consenting to the out-of-network charge. But \u201cwhen I asked to get a copy of the form I signed, she asked if she could fax it,\u201d Greenblatt said. Greenblatt said no. The billing department then asked whether they could put the form in her patient portal, for which Greenblatt gave permission. No form materialized.<\/p>\n<p>When KFF Health News asked Mount Sinai about the case in mid-October of this year, Lee, the system\u2019s spokesperson, forwarded a copy of the three-page form \u2014 which Greenblatt didn\u2019t remember signing. Lee said the forms are presented as part of the flow of the check-in process and \u201cintended to be obvious to the patient as required by law.\u201d Lee said on average, a patient signs two to four forms before checking into the visit.<\/p>\n<p>But, according to the time stamp on the forms, Greenblatt\u2019s visit concluded before she signed. Lee said it is \u201cnot standard\u201d to sign forms after the visit has concluded, and said that once informed, patients \u201cmay contact the office and reschedule with an \u2018in-network provider.\u2019\u201d<\/p>\n<p>\u201cIf it was provided after the service was rendered, that is an exception and situational,\u201d she concluded.<\/p>\n<p>The business with the forms \u2014 their timing and their obviousness \u2014 is potentially a vital distinction. In December 2020, Congress enacted the No Surprises Act, designed to crack down on so-called surprise medical bills that arise when patients think their care is covered by insurance but actually isn\u2019t. Allie Shalom, a lawyer with Foley &amp; Lardner, said the law requires notice to be given to patients, and consent obtained in advance.<\/p>\n<p>But the legislation provides an exception. It applies only to hospitals, hospital outpatient facilities, critical access hospitals, and ambulatory surgery centers. Greenblatt\u2019s medical bill variously presents her visit as \u201cOffice\/Outpatient\u201d or \u201cEpisodic Telehealth,\u201d making it hard to \u201ctell the exact entity that provided the services,\u201d Shalom said.<\/p>\n<p>That, in turn, makes its status under the No Surprises Act unclear. The rules apply when an out-of-network provider charges a patient for care received at an in-network facility. But Shalom couldn\u2019t be sure what entity charged Greenblatt, and, therefore, whether that entity was in network.<\/p>\n<p>As for Mount Sinai, Lee said asking for consent post-visit does not comply with the No Surprises Act, though she said the system needed more time to research whether Greenblatt was billed by the hospital or another entity.<\/p>\n<p><strong>The Resolution:<\/strong> Greenblatt\u2019s bill is unpaid and unresolved.<\/p>\n<p><strong>The Takeaway:<\/strong> Unfortunately, patients need to be on guard to protect their wallets.<\/p>\n<p>If you want to be a smart shopper, consider timing the length of your visit. The \u201cBill of the Month\u201d team regularly receives submissions from patients who were billed for a visit significantly longer than what took place. You shouldn\u2019t, for example, be charged for time sitting in a virtual waiting room.<\/p>\n<p>Most important, even when you seek care at an in-network hospital, whose doctors are typically in network, always ask if a particular physician you\u2019ve not seen before is in your network. Many practices and hospitals offer providers in both categories (even if that logically feels unfair to patients). Providers are supposed to inform you that the care being rendered is out of network. But that \u201cinformed consent\u201d is often buried in a pile of consent forms that you auto-sign, in rapid fire. And the language is often a blanket statement, such as \u201cI understand that some of my care may be provided by caregivers not in my insurance network\u201d or \u201cI agree to pay for services not covered by my insurance.\u201d<\/p>\n<p>To a patient trying to quickly book care, that may not feel like \u201cinformed consent\u201d at all.<\/p>\n<p>\u201cIt\u2019s problematic to expect patients to read the fine print, especially when they feel unwell,\u201d Ganguli said.<\/p>\n<figure class=\"wp-block-image alignwide size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"3840\" height=\"2560\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg\" alt=\"A portrait of a woman indoors.\" class=\"wp-image-1785148\" srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg 3840w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=150,100 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=500,333 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=768,512 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=1270,847 1270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=1536,1024 1536w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=2048,1365 2048w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=770,513 770w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=840,560 840w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=570,380 570w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=370,247 370w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=270,180 270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=170,113 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=100,67 100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=120,80 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=1170,780 1170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=300,200 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=200,134 200w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=315,210 315w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=630,420 630w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/12\/DEC_BOTM_Greenblatt_002-resized.jpg?resize=1200,800 1200w\" sizes=\"auto, (max-width: 3840px) 100vw, 3840px\"\/><figcaption><span class=\"photo-credit\">(Shelby Knowles for KFF Health News)<\/span><\/figcaption><\/figure>\n<p><em><em>Bill of the Month is a crowdsourced investigation by <a href=\"https:\/\/kffhealthnews.org\/news\/tag\/bill-of-the-month\/\">KFF Health News<\/a> and <a href=\"https:\/\/www.npr.org\/sections\/health-shots\/2018\/02\/16\/585549568\/share-your-medical-bill-with-us\">NPR<\/a> that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? <a href=\"https:\/\/khn.org\/send-us-your-medical-bills\/\">Tell us about it<\/a>!<\/em><\/em><\/p>\n<aside class=\"meta-authors meta\">\n<p>\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"author-name\">Darius Tahir: <\/span><br \/>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/kffhealthnews.org\/news\/article\/telehealth-surprise-bill-december-bill-of-the-month\/mailto:DariusT@kff.org\">DariusT@kff.org<\/a>,\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/twitter.com\/dariustahir\" target=\"_blank\" rel=\"noopener\"><br \/>\n\t\t\t\t\t\t\t@dariustahir<\/a>\n\t\t\t\t\t\t\t\t\t<\/p>\n<\/aside>\n<section class=\"block--category-tag-list \">\n<div class=\"category-tag-list__content-wrapper\">\n<h3 class=\"block--category-tag-list__title\">\n\t\t\t\tRelated Topics\t\t\t<\/h3>\n<p>\t\t\t\t<a class=\"category-tag-list__contact-link\" href=\"https:\/\/kffhealthnews.org\/contact-us\/\"><br \/>\n\t\t\tContact Us\t\t<\/a><br \/>\n\t\t<a class=\"category-tag-list__tip-link\" href=\"https:\/\/kffhealthnews.org\/tips\/\"><br \/>\n\t\t\tSubmit a Story Tip\t\t<\/a>\n\t<\/div>\n<\/section><\/div>\n<p><script async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n","protected":false},"excerpt":{"rendered":"<p>In September 2022, Elyse Greenblatt of Queens returned home from a trip to Rwanda with a rather unwelcome-back gift: persistent congestion. She felt a pain in her sinuses and sought a quick resolution. Covid-19 couldn\u2019t be ruled out, so rather than risk passing on an unknown infection to others in a waiting room, the New [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":2165,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-2164","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-industry"],"_links":{"self":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts\/2164","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2164"}],"version-history":[{"count":1,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts\/2164\/revisions"}],"predecessor-version":[{"id":2166,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts\/2164\/revisions\/2166"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/media\/2165"}],"wp:attachment":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2164"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2164"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2164"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}