Elyse Greenblatt had an unpleasant surprise waiting for her after a telehealth visit. Greenblatt, a 38-year-old resident of Queens, New York, was experiencing persistent congestion after a trip to Rwanda. To avoid potentially exposing others to an unknown infection, she decided to book a telehealth visit through her trusted health system, Mount Sinai. However, what should have been a convenient and cost-saving experience turned into a big bill and confusion.
Greenblatt’s visit lasted only a few minutes and resulted in a diagnosis of sinusitis. She was prescribed an antibiotic and a nasal spray, and told to return if her condition didn’t improve. However, when the bill arrived, she was shocked to find that the telehealth visit was considered an out-of-network service. This meant that her insurance provider, Empire BlueCross BlueShield, did not cover any of the costs. Additionally, Mount Sinai made it difficult for her to contest the charge.
The total bill for the telehealth visit came to $660, which is significantly higher than the average cost of telehealth visits. Typically, the total cost of an urgent care telehealth visit is around $120, with only $14 in out-of-pocket charges. It is unclear how Greenblatt’s visit ended up being so much more expensive. The doctor’s description of the visit as moderately lengthy, despite Greenblatt’s recollection of it being quick and straightforward, likely played a role in the high cost.
Another confusing aspect of the bill was the out-of-network designation. Mount Sinai, being Greenblatt’s usual healthcare system, assigned her an out-of-network doctor. This was unusual, as the doctor was affiliated with Mount Sinai and should have been in-network. It was discovered that the doctor did not list any accepted insurance on their Mount Sinai profile page, further adding to the confusion.
Greenblatt’s attempts to resolve the billing issue were met with frustration. The doctor’s office did not respond to her inquiries, and the bill would disappear and reappear on her patient portal. When she called Mount Sinai’s billing department, she was informed that she had signed a form consenting to the out-of-network charge. However, when she requested a copy of the form, none could be provided. Mount Sinai later sent a copy of the form, but the timing was questionable, as it appeared that the visit had concluded before Greenblatt signed it.
The No Surprises Act, enacted in December 2020, aims to protect patients from unexpected medical bills. It requires notice and consent from patients in advance for out-of-network charges. However, there is uncertainty about whether Greenblatt’s case falls under the Act, as the entity that provided the services is unclear.
As for Greenblatt’s bill, it remains unpaid and unresolved. Patients are advised to be vigilant in protecting their finances when seeking telehealth care. They should time the length of their visits and question any charges that don’t align with the actual time spent with the healthcare provider. Additionally, even when visiting an in-network hospital, patients should always verify if the specific physician they are seeing is in-network. Informed consent should be clear and upfront, rather than buried in consent forms that patients may sign automatically and without fully understanding the implications.
