After a year of phone calls and appeals, a patient of a Virginia ASC has had her medical debt canceled after Medicare refused to cover a procedure that was moved from a hospital to an ASC, according to a Feb. 6 report from The Roanoke Times.
In November 2021, Shirley Klinger was scheduled for a tendon-release procedure at Carilion Roanoke (Va.) Memorial Hospital. Due to a pandemic-related staffing shortage, the hospital transferred Ms. Klinger's procedure to a separate entity, the Roanoke (Va.) Ambulatory Surgery Center.
Ms. Klinger believed that her procedure at the ASC would still be covered by Medicare, until she received a $3,373 bill from Roanoke in January 2022.
Ms. Klinger began making phone calls to get an explanation for the unexpected bill. She was told repeatedly that Medicare denied the claim from the ASC due to a medical coding "glitch" with the procedure.
Eventually, she came to learn that Medicare originally approved an "open" procedure, but the surgeon at the ASC decided to use a minimally invasive technique instead to provide an optimal patient outcome, according to the report.
Due to the switch, Medicare denied coverage after the fact. Ms. Klinger claimed that no one warned her in advance of the surgery that the procedure would not be covered by Medicare.
Ms. Klinger contacted Medicare, the ASC, Carilion and the local office on aging.
"I talked with Carilion's patient advocate department I don't know how many times. They told me there was nothing they could do," she told the Times.
One Medicare representative told Ms. Klinger the bill had been approved for payment, but another one informed her in a subsequent call that Medicare had reversed that decision. She appealed to Medicare three times, and faced denials in each case.
Ms. Klinger and her husband applied for debt forgiveness from the ASC, claiming they could not afford the bill, and the ASC reduced the charge to $1,600.
The Klingers refused to pay the bill, despite receiving notices from a debt collector. On Feb. 3, the ASC contacted the couple and said that the bill had been expunged.
The Klingers are not entirely sure why the remainder was cleared but believe it could be rooted in Carilion's business relationship with the ASC.
"We're continuing to collaborate with the Roanoke Ambulatory Surgery Center to review what happened and determine if it can be avoided in the future," Hannah Curtis, a media relations employee at Carilion, told the Times.