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AVONDALE, Ariz. - One mother fought for months to have a medical bill reversed. Melissa Sherman said she spent months reliving the moment her infant died in her arms, as she tried to fight her bill.
Until something changed.
A BABY IS BORN
The shiny silver box on Melissa Sherman's shelf helps the mother remember the day her youngest daughter was born.
The delicate container, decorated with an angel, is engraved with her little girl's name, Kaylee Marie Sherman, and the date of her birth, 7-11-2011.
That's also the date Kaylee died.
"She was born, and we just held her," said Sherman, with tears welling up in her eyes. "We just held her. That's all we did," she said.
Born at twenty-three weeks, Kaylee was too premature to survive. Her fragile body was so small, she could fit inside her mother's palms.
"She was breathing, but she didn't open her eyes," said Sherman.
Sherman savored the few moments she had with her little one, before Kaylee quietly passed away in her arms.
THE MEDICAL BILL
Eventually, Sherman received a hospital bill for the care she received at Banner Good Samaritan Medical Center, but she did not expect to receive one for little Kaylee, who died shortly after she was born.
"I didn't even expect to see a bill," she said, "because there was no life-saving measures taken. She didn't receive any medical attention at all."
Sherman said medical personnel took Kaylee's heartbeat, wrapped her in a blanket, and handed Kaylee to Sherman before she died. Sherman said Kaylee received no other care.
The original, Nursery Level 1 Care bill for Kaylee's expenses totaled $862.
"Even at that time," Sherman said, "I thought, how could it be possible to incur ($862) in charges when (Kaylee) was given no medical attention at all? That didn't make sense."
THE EXPLANATION FOR CHARGES
According to Rainey Daye Holloway, a spokesperson for Banner Good Samaritan Medical Center, the services associated with Nursery Level 1 Care generally include "routine daily accommodation charges."
According to the Medicare Provider Reimbursement Manual, Holloway said, the services include things like the "room, dietary and nursing services, minor medical and surgical supplies, medical social services, psychiatric social services, and the use of certain equipment and facilities for which a separate charge is not customarily made."
9 News Scripps sister station ABC15 and their Investigators asked Holloway to explain the specific services that Kaylee received at the hospital in order to incur Nursery Care Level 1 expenses. However, Holloway did not provide a detailed list.
"Despite the unfortunate outcome the hospital did incur expenses and those charges are accurate," Holloway said in an email to the ABC15 Investigators.
"Hospitals have expenses whether a patient lives or dies," she added.
Although Sherman questioned the original bill, she knew her insurance benefits would cover most of it.
Based on her benefits plan, she expected to be responsible for a percentage of the $862 cost in addition to her deductible.
She didn't expect what would happen next.
Due to a pre-determined, negotiated reimbursement arrangement between her insurance company and the hospital, her benefits plan allowed the hospital to be reimbursed $6,270.60 for the Nursery Level 1 Care services associated with Kaylee's birth and death.
That's more than seven times the cost of the original $862 bill from the hospital.
As a result, Sherman's out-of-pocket costs increased dramatically, too.
She eventually was asked to pay owed $896.73.
Despite the unusual charges, a representative for Sherman's insurance company, the hospital, and the third-party administrator for her insurance benefits plan agree the amount paid to the hospital and the charges Sherman received were accurate.
Nothing about the situation made sense to Sherman.
A MOTHER'S FIGHT
Sherman said she made extensive phone calls for several months, disputing her expenses and the bill associated with her baby's birth and death.
"It's been hard because every time I call there I have to explain to them what happened," she said, "and I don't want to relive it over and over, so it's been really emotional."
But, when the ABC15 Investigators started making calls on the case, Sherman said, something changed.
"I told the billing manager at Banner that I was working with ABC15, and the bill got resolved almost immediately," she said.
Sherman said her charges were reversed.
"Banner Health extends our heartfelt thoughts to Melissa Sherman and her family on the loss of their child," said Holloway. "With respect to billing issues, we are glad to have resolved this situation."
Sherman said she also received a letter signed by Larry Volkmar, Banner Good Samaritan's CEO.
"We apologize for the confusion that has arisen from the charges associated with your daughter's very brief stay with us prior to her passing," the letter said.
"While we have audited your bill and found it to be in compliance with our internal standards, as well as our agreement with your
insurance company, we recognize that this is a difficult and emotional situation," the letter continued.
"As such, I (Larry) have recommended that we adjust the bill associated with your daughter's stay to zero as a courtesy to you and your family. We will remit all payments received toward this account to you and/or your insurance company respectively….Again, please accept my condolences for your loss."
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