Spokane E.R. patients hit with hundreds in unexpected charges


by Katie Utehs


Posted on February 2, 2012 at 7:16 PM

Updated Friday, Apr 27 at 2:26 PM

SPOKANE-- Patients of Providence Holy Family Hospital are caught in the middle of a battle between doctors and a major insurance company.
The emergency room physicians, who are independent of the hospital, are no longer contracted with Premera Blue Cross.
Now customers are opening large unexpected bills after treatment at the E.R.

Cindy Grabenstein opened her hospital bill and it made her heart flutter. "It really ticked me off. I knew nothing about it. I worked for a nurse there for about 12 to 13 years I’ve never heard of this."

On October 15th Cindy went to Providence Holy Family with chest pains. Cindy says she has gone their numerous times.

She was treated and released only to receive a bill in December for $824, she had to pay out of pocket.

Her insurance, Premera Blue Cross, wouldn't pay the full amount of what the doctor had charged.

That is because the E.R. doctors at Holy Family who belong to a group called "Emergency Physician's Services" are no longer contracted with Premera.

Negotiations broke down last summer when the physicians asked Premera for a rate increase.

The insurance company released a statement saying the doctors charged more than they were willing to pay. "The group requested a rate increase significantly above those of similar providers in our network."

The contract between the E.R. Doctors and Premera was dissolved.

"My idea was if a hospital was contracted then everybody in the hospital was contracted, but I found out that's not true" Cindy told us.
Neither Premera nor the physician's group will say how much more the doctors asked for.

Cindy's examination and tests cost $1332 dollars. Premera made a payment of $241 dollars and an adjustment of $266, leaving Cindy’s out of pocket cost $824.

"In the middle of my heart attack I didn't think to call Premera, I’m sorry." Cindy said.

The doctor's group declined to comment to KREM 2 news, citing on-going negotiations.

The president of the group, Dr. Lynn Brown, told the Journal of Business, "It was not that we want to fight anybody. We just have a small business to run."  He said they were no longer able to absorb the cost of low reimbursements.

Now patients are caught in the cross fire.

Other E.R.'s in the region are still contracted with Premera.
Deaconess Medical Center, Valley Hospital and Medical Center and Providence Sacred Heart Medical Center.
As of December 31st Premera had 54,000 members in Spokane County.

The hospital released this statement saying, "We urge both organizations to continue their negotiations to resolve this contractual issue quickly in order to serve the best interest of the residents in north Spokane."

In the meantime, the E.R. physicians will still take the Premera payment, but just like in Cindy’s case; it may not cover your whole bill.

Premera says they mailed notifications of the contract change to people who live near the hospital or had used the hospital over the last year.

Cindy lives in Mead and says she never received notification.
After many calls she says her bill has been dropped by both the physician's group and Premera.