Linda DeLaura never felt good about the $100,200 check addressed to her.
“At first, I thought, I don’t want this in my possession, because I don’t know why it’s coming to me,” she told 9Wants to Know.
Blue Cross Blue Shield sent the check in January, the insurance check didn’t exactly come with specific instructions.
It did, however, reference a company known as BHLH, LLC.
She called the number for the company and was told she needed to endorse the check and send it to an address in Texas.
While that might sound unusual, it’s hardly unusual for insurance companies to process out-of-network claims by sending payments directly to patients under the expectation the patients will forward the money to the out-of-network provider.
In DeLaura’s case the payment was for the intraoperative neuromonitoring, or IOM, her surgeon had elected to utilize during her September 2015 back surgery inside Parker Adventist. BHLH did not have a contract with her insurance at the time and was thus considered out-of-network.
This type of monitoring, in simple terms, relies on technical equipment that monitors activity within the patient’s central nervous system during a surgery. In practice, it provides the surgeon with a warning should he or she start coming close to doing any potential long-term damage to the patient’s spinal cord, for example.
Not knowing much about the cost of IOM, DeLaura told 9Wants to Know she felt she had no other choice but to send the check directly to BHLH’s billing address in Plano, Texas.
“Even still, the amount of money seemed very unusual,” she acknowledged.
9Wants to Know has found many IOM procedures typically result in charges to private insurance companies of no more than a few thousand dollars.
Medicare won’t even pay that much. In Colorado, for example, Medicare reimburses on the main billing code for IOM at the rate of a little less than $34 for every 15-minute increment.
A two-hour surgery using IOM will thus result in a payment of no more than a few hundred dollars.
BHLH wanted significantly more.
It’s not the first time 9Wants to Know has uncovered similar charges for IOM done inside Parker Adventist.
In November, we brought you the story of Dave and Debra Altman.
Late 2016, UnitedHealth mailed the Altmans a check for $169,600 to pay BHLH for the IOM done during a 2015 back surgery for Debra.
The check, which arrived more than a year after the surgery, was also to be mailed to an address in Plano, Texas.
In addition, 9Wants to Know has been in contact with Michael and Shannon Coons.
In May, Shannon Coons noticed a series of charges on her Explanation of Benefits (EOB) from Anthem Blue Cross Blue Shield which totaled close to $200,000.
The claim came from South Downing LLC for IOM performed during a 2016 back surgery for Shannon Coons inside a Parker Adventist operating room.
In the end, Anthem paid a portion of the charges to South Downing directly. Coons’ EOB shows South Downing was paid a little more than $38,000.
In all three cases, the patients never had to pay a dime to BHLH or South Downing LLC.
But that’s not what bothers them.
“I just can’t in good conscience send someone a check like that for work that doesn’t seem to be worth that much,” said Dave Altman. “The numbers just don’t make sense.”