Patients caught in middle of ‘outrageous,’ and ‘unjustified’ bills
Author: Chris Vanderveen
Published: 2:17 PM MST December 20, 2017
Updated: 10:58 PM MST December 20, 2017
MEDICAL-COST 2 Articles

DENVER – On at least three occasions, a Colorado-based medical provider charged Parker Adventist Hospital patients – through their insurance companies – more than $100,000 for a relatively common, operating-room based procedure, according to an ongoing investigation by 9Wants to Know.

Shortly after 9Wants to Know informed the hospital of the charges – charges one longtime Colorado doctor calls “outrageous” – the hospital’s owner, Centura Health, ordered an internal policy review of how it works with third-party medical companies.

The patients’ stories all share a similar theme. Each went to Parker Adventist for a back surgery and then, months later, happened to notice six-figure charges on his or her insurance paperwork for something known as intraoperative neuromonitoring.

All of the claims referenced one company:

South Downing, LLC.

According to the company’s own website, South Downing also does business as BHLH, LLC.

EXPLORE

Patients caught in middle of ‘outrageous,’ and ‘unjustified’ bills

MEDICAL-COST
Chapter 1

class="chapter-marker-sub" data-title="CHAPTER 1">The amount of money was very unusual

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.

Linda DeLaura received a check for $100,200 from her insurance company – and was asked to send that check to BHLH, LLC.

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.

At least three patients who went to Parker Adventist for a back surgery later learned their insurance had been charged over $100,000 for intraoperative neuromonitoring.

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.

Dave and Debra Altman review surprising medical bills with 9Wants to Know investigative reporter, Chris Vanderveen

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.”

Chapter 2

class="chapter-marker-sub" data-title="CHAPTER 2">Whiskey distiller behind charges

According to Colorado Secretary of State records, both BHLH and South Downing, LLC are run by a man by the name of Adrian Panther.

Panther, a longtime medical device sales representative currently owns Panther Distillery in Osakis, Minnesota.

“We’re proud to be Minnesota’s first craft distillery and we’re dedicated to continuing Minnesota’s heritage of exceptional distilled spirits that goes back to Prohibition,” suggests the company’s website.

Adrian Panther is the owner of Panther Distillery in Osakis, Minnesota – and also runs South Downing, LLC.

To date, Panther has refused to answer any questions to 9Wants to Know, opting instead to have his Denver-based attorney correspond with us.

Instead of answering specific questions, Kate Bailey of the law firm Messner Reeves has criticized our coverage of the story. “We can deduct from your categories that you are coming at the story from a biased and uninformed position,” wrote Bailey in an August email.

“We will not put our client or ourselves in a position to be steamrolled or vilified; nor do we think that it is helpful for anyone to have Mr. Panther speak for an industry in which he is barely a participant,” she added.

According to Colorado Secretary of State records, Panther’s name is attached to a number of other companies in Colorado including Mid-Town Neuromonitoring, LLC., NuerIOM, the now-defunct NeuroTech Monitoring, and Bad Medicine Distillery, LLC.

When asked why BHLH might have charged Deb Altman’s insurance more than $169,000 for IOM, Bailey wrote, “We will certainly review whatever you choose to publish and pursue all legal remedies for the publication of false information. Mr. Panther is represented by counsel, which means you may not contact him directly.”

We have yet to receive an explanation from either Bailey or Panther as to why BHLH’s claims are sometimes in excess of $100,000.

9Wants to Know also reached out to Centura Health, the owner of Parker Adventist.

In a prepared statement, Centura’s Chief Clinical Officer Dr. Brian Erling said Centura doesn’t always see the amounts charged by independent providers who work inside their hospitals.

“When we do not have a contract with a provider, we have no visibility into their billing practices,” wrote Dr. Erling.

In this case, however, Dr. Erling said the charges presented to Centura represent a case of “rare insight.”

And, because of that, “Centura Health is taking further action to review our provider credentialing processes.”

Neither Dr. Erling nor any other representative from Centura Health would elaborate on the timeline or scope of any internal review.

In addition, two of the back surgeries reviewed by 9Wants to Know involved a surgeon by the name of Dr. Scott K. Stanley. Dr. Stanley is a Facebook friend of Adrian Panther’s and appears with Panther in a picture on his Facebook page.

When asked if he had any business relationship with any IOM companies – including South Downing LLC -- Dr. Stanley replied in an email, “Like many physicians, I have business interests outside my practice of medicine. Those too, have always been focused on one thing - providing excellent care to patients. Those business interests were disclosed to Centura and no concerns have ever been raised with me regarding those business interests by Centura, by any insurance company, or by any patient.”

On Dec. 19, Dr. Stanley said in an email: “All of my surgical patients do receive information on IONM, billing practices, contact numbers for questions, and they all consent to the potential for out of network EOB’s after an informed and thorough discussion. I do not keep information from my patients and your suggestion that I do not care about the holistic well-being of my patients is offensive and flies in the face of the care I give and guidance I provide through the process.

“I am once again asking that you cease your ongoing efforts to interfere with my medical practice and patients. Please be advised I will consult with counsel if you continue with your threats, your harassment and intimidation tactics.”