During my time as a Families USA intern this summer, I had the immense pleasure and honor to work with the communications team, and help them with their storytelling program. Through their storytelling efforts Families USA was able to help healthcare consumer, Sonji Wilkes, voice her experiences with surprise bills. I was given the amazing opportunity to write about her testimony in front of Congress (which incidentally happened on my first day at work, it was a really exciting day!) Below is the blog!
In 2003, Sonji and Nathan Wilkes from Englewood, Colorado, were eagerly awaiting the arrival of their second child. After already experiencing a brush with surprise medical billing during the birth of their first child, the parents were now more informed about the process.
So imagine their shock when they received a bill for $50,000 after their newborn son Thomas was diagnosed with severe hemophilia A and had to be treated by the hospital’s Neonatal Intensive Care Unit (NICU). This happened because, unbeknownst to them, the hospital had subcontracted the NICU to a third-party provider that was not a part of any insurance company network. The couple tried to dispute the claim, but the company insisted that the couple had acquired a $50,000 debt that needed to be paid. They refused to pay the bill because they felt that they had made every effort to stay within their insurance network based on the information they were provided.
“I would have never thought to check if the NICU, just 50 or so steps from the room I gave birth in, was in-network. I think any reasonable person would assume it to be because it seems reckless and cruel to me that it would not,” Sonji said.
This experience was the catalyst for Sonji testifying June 12, 2019 before Congress at a hearing on surprise medical bills—the exact type of bill she and her husband received. Surprise medical bills occur when consumers are charged for care from out-of-network providers that they receive due to no fault of their own. Families who make the best attempt to navigate the health coverage and care system by identifying in-network facilities and providers still receive surprise medical bills that can amount to hundreds, thousands, and even tens-of-thousands of dollars. According to a 2019 Kaiser Family Foundation poll, four out of 10 respondents said they had received an unexpected bill from a hospital, lab, or doctor in the past year.
The hearing, convened by the House Committee on Energy and Commerce Subcommittee on Health, was entitled “No More Surprises: Protecting Patients from Surprise Medical Bills.” The committee has released its draft No Surprises Act. This legislation takes critical steps to hold families harmless from surprise bills and ensure that payments between insurers and out-of-network providers are not inflationary, so that families do not experience increased insurance premiums.
Sonji’s harrowing experience underscores why Congress needs to enact robust legislation to protect families from surprise medical bills. Since she and her husband refused to pay the bill, it was turned over to collections then dismissed several years later as part of a class action lawsuit. But the ordeal still ruined their credit rating and they thought they might not be able to keep the minivan they needed to drive Thomas to his appointments at the Hemophilia Treatment Center. They were able to keep the minivan and Thomas is currently learning how to drive it.
"Consumers should be protected from expensive surprise medical bills in emergency situations or when they believe that they are appropriately seeking care from in-network providers," Sonji said. "No family should face financial ruin because they are duped into thinking they are at an in-network facility or because their in-network provider contracts out services like radiology, lab services, imaging, or more without the patient’s knowledge."
Like Sonji, Families USA feels that consumers should always be protected from surprise medical bills. The organization supports the No Surprises Act, but recommends three significant changes to better protect consumers from egregious and unpredictable surprise bills:
Expansion of consumer protections to ensure all provider and facility surprise bills are captured
Establishment of federal surprise billing law as a protective “floor,” so that states cannot implement weaker laws that undermine it
Improved consumer notice requirements
“When you are told that your baby is bleeding and his body lacks the ability to stop and that he needs immediate specialized treatment, your first reaction isn’t, ‘Gee, I wonder if that’s in-network;’ your first reaction is, ‘By all means, do whatever it takes to help my baby,’ ”
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