A patient at a prominent medical group in Milwaukee has raised concerns over what she alleges is a "deceptive billing practice" following an unexpected charge after a recent appointment.
Julia Ubert contacted TMJ4 to share her experience. "I’m not the only one," Ubert said. "I’m sure someone else has gone through this and shares the same viewpoint. Seeing this might encourage others to stand up to Aurora and say, 'Hey, this isn’t right.'"
After an appointment that Ubert says she did not request, but was told she was required to attend, she was shocked to receive a bill for nearly $500.
Watch: Frustrated patient challenges Aurora Healthcare
This issue dates back to last fall, after Ubert’s primary care provider moved out of the area. Ubert says she was informed she needed to participate in an “establish care” appointment to meet her new doctor.
"I’ve had vague answers and no answers. I’ve come to the end of my rope," Ubert expressed during her interview. Feeling increasingly frustrated about the bill, she decided to reach out to TMJ4 for assistance.
Ubert is not only disputing her bill; she’s advocating for a change at Aurora Healthcare. "A small claims suit isn’t going to resolve this. A complaint with the state isn’t going to help me, my family, or anyone else in the community avoid these charges," she emphasized.
The billing issue stemmed from what Aurora Healthcare categorized as an “establish care” appointment. Ubert recalled asking what this entailed: “They said it’s just a meeting with the doctor, to get to know the doctor — no exam, just a get-together."
Aurora billed $755 to Ubert’s insurance for the appointment, resulting in a $484 out-of-pocket expense for her. "This was completely not at all what they said it would be," Ubert stressed.
Despite multiple attempts to dispute the charges with the billing department, Ubert reported that she never received satisfactory answers. "No," she replied when asked if anyone within the Aurora system had adequately addressed her concerns.
Aurora declined to participate in an interview with TMJ4 but provided a statement: "An establish care visit is a patient’s first appointment with a new physician, within the same facility or practice in which they previously were seen. How insurance companies process such visits (compared with annual checkups, for example) may vary, so patients are encouraged to check with their insurance providers in advance to avoid unexpected costs."
It’s a step that Ubert insists she took. "My understanding was that it was a preventative care appointment to meet the doctor. It was not a medical appointment. I did not receive any treatment," Ubert explained, recalling her conversation with her health insurance provider.
Sadie Tuescher, owner of Wisconsin Health Insurance Advocates, assists people facing similar billing controversies.
"Both the insurance company and the provider almost always pass blame. I don’t know if I’ve ever had a case where I haven’t heard, ‘Go talk to the insurance company,’" Tuescher noted.
Her advice is clear: If you receive a disputed bill, do not pay it, even under the threat of collections. "Call and ask them to freeze your account while you are dealing with insurance," she advised. "If you pay that bill, the hospital system has no incentive to work with you to recode the bill for insurance reimbursement."
Tuescher also noted that in many cases, billing issues can be traced back to coding errors, which Ubert learned had occurred in her situation.
Tuescher says another thing you should do when you get a bill that you don't believe you should have gotten is compare it to your "explanation of benefits" or EOB. It is the document sent to you after your health insurance company processes a claim.
"That is the form that will show you why it was denied or if it was applied to the deductible or if it was applied to preventative care," she explained.
After Ubert's situation was flagged by TMJ4, Ubert received a call from Aurora, notifying her that the charge would be removed. Although she is relieved, she plans to switch healthcare systems moving forward.
When TMJ4 asked for clarification about attending an "establish care" appointment, a spokesperson for Aurora Health Care stated it is not required but is highly recommended.
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