Kidney punch

A $ 540,000 dialysis bill showcases health care ills

Ridiculous snafus such as the story of a Montana man whose family was billed more than $ 540,000 for a series of dialysis sessions should alert the private health care/ insurance market that it could put itself out of business.

Sovereign Valentine, a

50- year- old man from Plains, Mont., started undergoing dialysis in January after going into kidn e y f a i l u r e . H e w e n t through 14 weeks at a Missoula clinic, 70 miles away, which then sent him a bill for $ 540,841.

This shocking case of overbilling was highlighted on CBS News as part of its series “Bill of the Month,” a crowd- sourced investigation that focuses on the health care bills faced by ordinary Americans.

A medical system that would mindlessly mail out a bill of more than half a million dollars to a patient is a medical system in need of reform and oversight.

A medical system that would charge a patient $ 13,867 for one kidney dialysis session is a system that cries out to be brought under government oversight. The price charged to Mr. Valentine and his wife was about 59 times the $ 235 that Medicare pays for a dialysis session.

Yes, the Medicare price — as in “Medicare for all” — for Mr. Valentine’s sessions is $ 235.

According to the insurance company, it was all a simple misunderstanding.

Mr. Valentine said he had to go to Fresenius Kidney Care clinic in Missoula, an out- of- network care facility, because his insurance company, Allegiance, told him there were no in- network dialysis clinics in Montana. Allegiance contends that it only informed Mr. Valentine’s wife, Jessica, a physician, that there were no in- network dialysis clinics in Missoula. Dr. Valentine has not disputed this claim.

After reporting by several media outlets, including National Public Radio, CBS and Kaiser Health News, Fresenius agreed to waive Mr. Valentine’s bill for out- of- network dialysis care.

Even if Dr. Valentine should have listened more carefully to what was being said, there should be better communication and sharing of burden in our health care system. If there is a dialysis facility in Missoula, it should be made available to people living in and near Missoula.

The insurance industry was flexible and generous enough to accommodate Mr. Valentine’s need for local dialysis without fussing about how it would be paid for, and then to slash his bill by the full amount when the situation came to light.

But how much more often is a much smaller, but still crushing medical bill, not zeroed out in the absence of news coverage? How often is medical care rejected because it is not “in network,” though the facility might be right down the street?

These are issues that the private health insurance industry must resolve to survive. Citizens should not have to count on getting news coverage to get necessary health care and have it paid for in a transparent, fair and commonsense way.