Kevin Fritz felt awful the afternoon of Sept. 21, 2016. A coworker wondered if it was a heart attack. Another decided he needed to go to the hospital.
“It looked like I took a shower with my clothes on. I was sweating that badly,” he said.
They quickly decided Sky Ridge Medical Center was his best option. Not only was it relatively close, but it was also in-network with his UnitedHealth insurance.
By the time his wife Juanita arrived, ER staff members were focusing not on his heart but his intestinal tract.
“It turns out his intestines had twisted,” Juanita Fritz said.
It was a serious, potentially fatal, problem. Kevin needed an emergency surgery.
It likely saved his life.
Months later, the couple couldn't remember if anyone at the hospital told them the surgeon wasn't in-network with UnitedHealth, but the Fritz's did receive a bill indicating as much.
The bill came from South Denver Acute Surgery – a billing company that represents the surgeon.
UnitedHealth, according to the bill, had already paid the surgeon $1,712.56 for the claim.
Still, the billing company demanded an additional $2,401.44 for Dr. David Jones. It was, to put it bluntly, money the Fritz's did not have.
“I praise God that he was there to help my husband, but I had no idea that he was out-of-network,” Juanita said. “I'm unemployed. My husband is the only income right now. We're talking about one of his paychecks.”
And technically, according to Colorado law, it was also money they didn't really owe.
Dr. Jones did not respond to 9NEWS requests for comment.
The Fritz's are hardly the only patients to receive a surprise bill from an out-of-network provider.
A study published in the New England Journal of Medicine late last year concluded as many as 22 percent of ER visits to in-network facilities result in a surprise bill from a provider not in the patient's insurance network.
And it's not just ER visits that result in out-of-network, surprise bills.