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Problem Solvers help parents of triplets fight confusing medical bills

Posted at 10:55 AM, Sep 21, 2021
and last updated 2021-09-21 10:55:44-04

CHESTERFIELD COUNTY, Va. -- A family in Chesterfield is relieved to have nearly $3,000 in medical bills for their triplet toddlers off their shoulders after calling the CBS 6 Problem Solvers.

“Truthfully, we barely knew what was going on. It was kind of a whirlwind,” mother Erin Silber said of the sleep-deprived weeks immediately following the arrival of her three children. “When you haven’t had any kids before everything is new.”

Born in January 2020, the trio required 13 days in a NICU before leaving the hospital. Their pediatrician advised Erin and her husband, Andrew, to have twice weekly weight checks for the children until they grew stronger.

“At the time, we didn't think anything of it, because our only exchange with the doctor was he said, ‘you can come in and get weighed, or you can have somebody come to your house and weigh them,’” Andrew Silber told the Problem Solvers.

Under the impression that the service would be covered by their health insurance policy, and concerned about repeatedly exposing their premature children to illness in a doctor’s office, the Silbers opted for the home health services. Referred by their doctor, Thrive Skilled Pediatric Care sent nurses to routinely weigh the triplets and delivered specialty formula to the family.

Months after the children no longer needed weight checks, dozens of bills began arriving in the mail. Only then did they realize the service was not covered entirely by their insurance. The Problem Solvers reviewed the invoices collected by the Silbers. The bills charged $300 per hour for each child, every visit, adding up to $900 for care the Silbers say took no more than half an hour total.

“If we would have known it was going to be so expensive, we probably just would have bought a scale and then reported that to the doctor or researched different companies to see if something worked better,” says Erin Silber.

Overwhelmed and outmanned by three growing toddlers, the bills continued to mount. The Silbers are both frontline workers rotating child care duties with their shifts at work.

“They kind of have you at a loss because the only times that we can contact them is between 9 a.m. and 5 p.m. but the kids are awake then and we’re mostly trying to single parent them while the other works,” said Andrew Silber.

The couple sent $10 payments per child until they could take the time to call Thrive SPC but say they couldn’t get a straight answer on exactly how much they owed or why.

“I asked for a total and they were unable to give me one. I don't know what the hang-up was but eventually, I got a little bit more aggressive with them and said, ‘you know, if we can't come to a resolution to this, then we have to seek other sources to help us with this,’” claims Andrew. “That's kind of when they shut down all communication and said we're not getting any more records after that.”

The Silbers say less than a week after that phone call they began receiving collections notices, despite making minimum payments.

The Problem Solvers contacted multiple executives at Thrive SPC’s headquarters in Massachusetts. The company’s Chief Compliance and Regulatory Officer, Roberta Verville, promptly reached out to the Silbers to hear about their experience.

In a follow-up email to the family, Verville notes multiple opportunities where the company could have been more timely and explicit with communications but says an error by the Silbers’ insurance company caused an unexpected delay in the billing system. Once corrected, the Silbers’ patient responsibility totaled less than $3,000. Verville acknowledged the Silbers’ concerns should have been escalated sooner to company leaders and says Thrive SPC could clarify bills for future patients by noting nursing visits are charged by the patient, not by the hour.

As a gesture of thanks for the Silbers’ service as essential workers in the midst of the pandemic, Thrive SPC pulled the Silber bills out of collections and cleared their accounts to reflect $0 balances.

Additionally, at the Problem Solvers’ request, Verville advises other new parents so that they might avoid similar situations. Below is Thrive SPC’s response.

  1. Be sure that after (or before?) phoning friends and family about the good news and the arrival of the baby/babies, that you contact your employer and health plan to have the babies added to your health insurance policy;
  2. Know that the best source of information about if/whether a product/good/service is covered and what your financial responsibility will be is to review your Member Benefits and with the provider that will be delivering that service;
  3. Remember, just because a service is “covered” does not mean that it will not incur out of pocket expenses for deductibles or coinsurance amounts;
  4. And, when in doubt about how a service is reflected on an invoice or claim, most providers have a Compliance Hotline where fraud, waste, and abuse questions can be asked (e.g., concern re: hourly billing vs. visit was easily clarified and no evidence of fraud);
  5. Lastly, if you are fighting claims that have been sent to any collections agency, be sure to communicate that the claims are being contested in order to halt further collections action while the matter can be resolved.

Thrive SPC is grateful for the assistance that Channel 6 is offering to patients and families. The health care delivery system in the United States and the insurance systems here are complex, have language that is difficult to navigate for most people, and advocates like you help to translate the complexities while advocating for fairness, clarity and understanding.

The Problem Solvers are Working on Your Bill. If you’ve received a medical bill you weren’t expecting, click here and send us as many details as possible.