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Utah couple stung by insurance policy's fine print

Published October 21, 2012 6:10 pm

Medical debt • America's complicated, fragmented system of providers and insurers hard for patients to navigate.
This is an archived article that was published on sltrib.com in 2012, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Editor's note: This is a part of a package of stories about Utahns and medical debt. See Related Stories box below.

Jeff Riehl couldn't catch his breath and figured he had pneumonia, but was surprised to learn his right lung had collapsed.

It happened twice, once in 2010 and again in 2011. The cause of his spontaneous pneumothorax: unexplained bubbles of air that would explode and increase pressure in his chest.

The 51-year-old father of three, an avid skier and non-smoker, has long since recovered from surgery to remove the problem-causing fourth of his lung. But only recently did he settle the $60,000 hospital bill.

Riehl's insurer, Humana, refused to pay because the surgery was done at an out-of-network hospital — a fact Riehl learned while in intensive care.

"The surgery was scheduled as an emergency, but we made sure the lung specialist was listed as a preferred provider on our policy. No one warned us that the hospital was out-of-network," said Jeff's wife, Tlesa Riehl.

The insurer wanted to put Riehl in an ambulance and move him to another hospital. But the only option was an orthopedic facility. "They had a lung doctor on their panel with no place to do lung surgery," Tlesa Riehl said.

The surgeon advised against the transfer, telling the Riehls not to worry, it would work out. But after months of appeals, Humana wouldn't budge.

Eventually, the hospital wrote off all but $1,200. The Riehls had already paid their $7,500 deductible, most of which went to the surgeon. The anesthesiologist agreed to take $500.

"The crazy thing is the insurance company paid nothing, and when it came time to renew our policy they raised our monthly premiums from $380 to $540," said Tlesa.

The Park City couple was looking to buy a home, but haven't replenished their savings.

Two consecutive years of hospital visits and meeting their deductible, plus premiums, adds up to nearly $23,000 in out-of-pocket spending. "I'm a contractor. Coming up with that kind of money takes awhile," Riehl said.

Tlesa Riehl sees no relief on the horizon.

"It's easy to be mad at insurance companies, but it's complicated. While he was in the hospital they gave us a sample-sized bottle of cream for his cold sore, and billed us $260 for it. It was criminal," she said. "The whole thing is baffling to us. We don't even know where you begin to fix things."