CBS News reports that a man was hit with a bill of almost $90,000 after a serious car accident despite having insurance.
When Mark Gottlieb was hit by another car while driving in January of 2019, he damaged four vertebrae and smashed several teeth.
“A car basically came out of nowhere. I thought I was going to die,” he told, “CBS This Morning.”
His Geico Car Insurance plan covered $250,000 of medical care. After physical therapy and other treatments that Geico covered, Gottlieb needed spinal surgery. He didn’t pre-clear the surgery with his medical insurer, Aetna, because he thought he would be covered by the money left in his Geico plan. But the hospital and surgeon’s bills totaled over $700,000.
“It was no pain compared to when the bills came,” he said.
Geico negotiated both bills down substantially and paid more than $150,000 towards Gottleib’s charges, before his plan was exhausted, leaving him on the hook for about $90,000 for the surgeon’s bill.
“I figured a quarter-million dollars is a lot of insurance. I just, it didn’t make any sense how that could happen,” Gottlieb said.
He submitted the surgeon bill’s balance to Aetna. Aetna told CBS News that it offered to pay the standard rate of care under Gottlieb’s policy. But because the surgeon and his office were out of network, he would still owe over $4,000 to meet his deductible. So he withdrew his request for Aetna’s coverage.
After this experience, he fears seeking any additional treatment to help with his existing back pain, even from an in-network doctor.
“I am doing absolutely nothing. I’ll take extra strength, Tylenol. You know the last thing I want to see happen is I go to the doctor regarding this, and I end up getting some humongous bill. I have a huge fear because of what happened,” he said.
Dr. Elisabeth Rosenthal, editor-in-chief of Kaiser Health News, told “CBS This Morning” co-host Anthony Mason that health and auto insurance don’t work well together after car accidents.
“Well, the first thing to know if you’re in an accident and you have personal injury protection insurance through an auto insurer, that kicks in first, and that pays the first part of the bill. But they work really differently, first of all, they have smaller networks, in some states, including New Jersey, they have set rates they pay for procedures. But if the surgeon and the hospital add a few things that aren’t on the rate list, they can charge whatever they want. The sky’s the limit,” Rosenthal said.
Rosenthal recommends that patients get price estimates from their medical facilities if it’s not an emergency procedure.
“They should try or at least get it in writing and don’t get it, you know, a lot of people will tell me, ‘Well, you know, I called the billing office, and they said don’t worry.’ So you have to get it in writing from the finance office, and then at least you have something to fight with, ‘Look, I have an estimate in my hand. So, honor it,’” Rosenthal said.
Hudson Regional Hospital said in a statement that it “charged the state-mandated fee for all applicable services to Mr. Gottlieb, and for the balance of his care, the charges were reasonable.”
The surgeon and his office, Bergen Pain Management, have not pursued Gottlieb for the almost $90,000 outstanding bill.