3 On Your Side

"In-network" billing dispute leaves man feeling ill

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Valley man was shocked when his medical bill came for his blood draws. (Source: KTVK) Valley man was shocked when his medical bill came for his blood draws. (Source: KTVK)
HonorHealth in Scottsdale (Source: KTVK) HonorHealth in Scottsdale (Source: KTVK)

We all know exercise is important, but for James Scholz getting out and moving around is a requirement these days.  

"I take my dog out for a walk around two to three times a day," Scholz said.

Scholz says he has to stay active due to a blood disorder. 

“The more you keep your blood moving, hopefully, it will keep you going stronger," Scholz said. "You don't want to be sitting around with bad blood in your body."

To help take out some of that bad blood, Scholz has blood draws done on a regular basis, and the facility he goes to is connected to HonorHealth in Scottsdale.

Scholz says he's been having the medical procedure done for years and always paid less than a $100 to get it done.  

"It was always around the same. Less than $100 was our part. And the insurance would pay their part of it, and the hospital would always say okay, everything is great. We're all square,” Scholz told 3 On Your Side.

And following a blood draw back in 2015, everything was square. Not only did his insurance company say he owed around $81.00 but HonorHealth sent him a letter indicating the same amount.

However, several months later, HonorHealth is now pursing Scholz and his wife for two $600 blood draws totaling more than $1,200.

Remember, they only use to pay around $80 per blood draw, not $600 each. Scholz says he can't understand it. He's been having the same blood procedure done under the same insurance, at the same facility for years now. So, why the big price increase?"

"Well, we contacted you, Gary Harper,” Scholz said.  “We can't get an answer one way or the other."

HonorHealth looked into the matter for 3 On Your Side and claimed it's not their fault.

In a statement, a spokesperson wrote, "... Mr. Scholz’ insurance company determined that the services were deemed out-of-network ... which resulted in additional patient responsibility due from Mr. Scholz."

But Scholz says that's impossible because he's had the same insurance for years and believes the dispute has something to when the hospital consolidated and changed its name to HonorHealth last year.

The hospital denies that assertion.

“I'm not going back to the facility again. I don't think. For what reason?  They're overcharging us,” he said.

What happened to Scholz can happen to any consumer.  

It’s a good reminder to contact your insurance carrier and verify your coverage.  Confirm with them that your doctor and any specialists that used to be considered “in-network” are still considered “in-network.”  It’s not uncommon for insurance carriers to modify coverage and you’re not made aware of it until it’s too late.

Copyright 2016 KTVK (KPHO Broadcasting Corporation). All rights reserved.

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