LISA: WE ALL KNOW GOING TO THE EMERGENCY ROOM IS GING TO COST YOU BIG TIME. TY: BUT A TRUCKEE WOMAN IS FACING SERIOUS STICKER SHOCK AFTER SEEING THE BREAK DOWN OF COSTS FOR A RECENT TRIP TO THE HOSPITAL. >> WHEN IT COMES TO BILLING YOU ANTICIPATE OUTRAGEOUS ER CHARGES. I KNEW THAT THOSE WERE COMING EVEN WITH INSURANCE. I JUST DIDN’T ANTICIPATE WHAT I SAW WHEN I DID GET THE BILL. TY: THE MOST OFFENSIVE — THE MOST EXPENSIVE PART OF THAT BILL WAS NOT THE SURGERY. LISA: KCRA 3 INVESTIGATES’ BRITTANY JOHNSON IS ON CASE AND JOINS US NOW. WHAT DID YOU FIND OUT? BRITTANY: THE SURGERY, BUT THE TETANUS SHOT. I CALLED AROUND TO OUR LOCAL PHARMACIES. THE SHOT CAN COST YOU ABOUT $60 TO $80 BEFORE INSURANCE. BUT WHAT KATE SPURRY PAID, WELL BEYOND THAT PRICE. BACK ON HER FEET, AND IN THE GARDEN. >> IT’S MEDITATIVE FOR ME. BRITTANY: KATE SPURRY SAYS IT’S TIME TO RELAX AFTER A STRESSFUL COUPLE OF MONTHS. >> I WASN’T ABLE TO GARDEN BECAUSE IT TAKES SO MUCH DEXTERITY. BRITTANY: OVER THE SUMMER, SPURRY INJURED HER FOOT ON A WHITE WATER RAFTING TRIP. >> I HAD BROKEN MY FOOT AND THERE WAS A BONE STICKING OUT. IT WAS PRETTY OBVIOUS I NEEDED THE NEAREST ER. BRITTANY: SHE HAD SURGERY AT MARSHAL MEDICAL CENTER IN PLACERVILLE. >> I GOT GREAT CARE. THEY DID A GREAT JOB. THEY STITCHED ME UP AND GAVE ME SOME ANTIBIOTICS AND TETANUS SHOT AND SENT ME ON MY WAY WITH SOME CRUTCHES AND A CAST. BRITTANY: BUT THAT’S WHEN THE HEADACHE STARTED. A MEDICAL EXPLANATION OF BENEFITS FROM HER INSURANCE COMPANY, SAYING THE COST OF HER TETANUS SHOT WAS MORE THAN $2100. >> I WAS FLABBERGASTED. BRITTANY: HER INSURANCE SAID IT WOULD COVER SOME OF IT, BUT SHE COULD STILL BE RESPONSIBLE FOR MORE THAN $1200. >> IT WAS MORE THAN THE ACTUAL PROCEDURE. WHY WOULD A SHOT THAT TOOK ABOUT 10 SECONDS TO ADMINISTER BE TWICE THAT OF A PROCEDURE THAT TOOK WELL OVER AN HOUR? BRITTANY: SHE SAYS SHE WASN’T EVEN SURE SHE NEEDED THE BOOSTER. >> I WAS ASKED WHEN MY LAST TETANUS SHOT WAS AND I WASN’T SURE BUT I THINK IT WAS ABOUT 2016. AND THE WAY THE CONVERSATION WENT WAS, WELL, LET’S GIVE YOU A BOOSTER JUST TO BE SAFE. SURE, RIGHT. BRITTANY: IN SHOCK, SHE SAYS SHE CALLED THE HOSPITAL SEVERAL TIMES OVER THE COURSE OF A WEEK, TRYING TO MAKE SURE THE BILL WAS CORRECT. >> THE GAL THAT I SPOKE TO SAID, NOPE, THAT’S CORRECT. AD EMERGENCY CARE IS ALWAYS MORE EXPENSIVE. BRITTANY: AT HER WITS END, SHE ALSO CONTACTED KCRA 3 INVESTIGATES. WE FINALLY GOT A STATEMENT FROM THE HOSPITAL’S CEO. SAYING THE HOSPITAL HAS THOUSANDS OF DIFFERENT CHARGE CODES FOR MEDICATIONS. AND ITS ALGORITHMS CAN LEAD TO ERRORS. SAYING QUOTE, A $2,000 TETANUS SHOT IS NOT ACCEPTABLE. THE STATEMENT GOES ON TO SAY, I WANT TO THANK THOSE WHO HAVE BROUGHT DISCREPANCIES TO OUR ATTENTION. NOW AFTER KCRA3 REACHED OUT TO MARSHAL MEDICAL CENTER, ITS PRESIDENT AND CEO SAYS IT IS NOW REVIEWING THEIR PRICING APPROACH FOR ALL MEDICATIONS. >> I DON’T KNOW WHAT THE OUTCOME HERE IS GOING TO BE, SO I DON’T KNOW IF WHAT I’M DOING IS GOING TO BE EFFECTIVE, BUT ASK QUESTIONS. CALL THE INSURANCE COMPANY. CALL THE HOSPITAL, ASK THEM QUESTIONS. BRITTANY: LATE THIS AFTERNOON, WE HEARD FROM KATE’S INSURANCE COMPANY WHO TELLS US AFTER RECEIVING ADDITIONAL INFORMATION, KATE’S CLAIM HAS BEEN REPROCESSED AND SHE NO LONGER OWES ANYTHING. LISA: THEY REALLY TOOK YOU GETTING INVOLVED FOR THEM TO TAKE A CLOSER LOOK AT THIS AND SAY THIS IS A MISTAKE, NOW SHE DOES NOT HAVE TO PAY. WHAT SHOULD OTHER PATIENTS DO IF THEY’RE CONCERNED ABOUT A BILL? MARK: TRUST YOUR GUT. IF YOU THINK SOMETHING IS WRONG, DO YOUR RESEARCH. IT TOOK A LOT OF RESEARCH AND US GETTING INVOLVED. THE HOSPITAL RECOMMENDS REACHING OUT TO A FINANCIAL COUNSELOR AT THE HOSPITAL, ALTHOUGH AS YOU DID HERE, IT MIGHT TAKE SEVERAL CALLS TO GET THE ANSWER YOU ARE LOOKING FOR. LISA: YOU HAVE TO BE PERSISTENT. IF YOU DON’T HAVE BRITTANY JOHNSON, BE PERSISTENT. MARK: BRITTANY: GIVE ME A CALL. [LAUGHTER] TY: THAT IS A LOT OF LEGWORK SOMEONE HAS TO GO THROUGH. BRITTANY, THANK YOU. IF YOU HAVE SOMETHING YOU WANT OUR INVESTIGATIVE TEAM TO LOOK THROUGH, SEND THEM AN EMAIL.

Truckee woman was hit with a $2,100 bill for a tetanus shot. Our inquiries helped drop those charges

Updated: 7:30 PM PDT Aug 24, 2022

We all know going to the emergency room will cost you big time, but a Northern California woman is facing serious sticker shock after seeing the breakdown of costs after a recent trip to the hospital. The most expensive part of the bill wasn’t even the surgery but rather a tetanus shot. Kate Spurry of Truckee injured her foot as she was getting ready to go white-water rafting in the American River.”Literally as we were packing the boats up the trailer fell on my foot so I didn’t ever even get in the water,” Spurry said. “I had broken my foot and there was a bone sticking out. It was pretty obvious I needed the nearest ER.”Spurry said her friends and family rushed her to Marshall Medical Center in Placerville where she underwent surgery. There, she said she received great care as they stitched her up, and gave her antibiotics and a tetanus shot before sending her on her way with some crutches and a cast.That is when the headache started.Spurry showed KCRA 3 Investigates’ Brittany Johnson a copy of her Medical Explanation of Benefits from her insurance company, which stated the cost of her tetanus shot was $2,180.63.Spurry said she was “flabbergasted” when she opened up her bill.Her insurance, under UnitedHealthcare, said it would cover some of the costs but noted that Spurry was responsible for $1,251.89.”It was more than the actual procedure,” Spurry said. “The actual procedure, which you can see here says surgery, is actually — I felt like that was a pretty good deal — that was a little over $1,300. So why would a shot that took about 10 seconds to administer, be twice that of a procedure that took well over an hour?”In shock, Spurry said she called the hospital several times to try and make sure her bill was correct.”The gal that I spoke to said, ‘Nope, that’s correct. Emergency care is always more expensive.'”At her wit’s end, Spurry contacted us for help.We called around to various pharmacies to inquire about the cost of a tetanus shot before insurance and found the cost was anywhere from $60-$80.KCRA 3 sent Spurry’s information to Marshall Medical Center, along with a series of questions.After our inquiries, the hospital said “A $2,000 tetanus shot is not acceptable,” and it is now reviewing its pricing approach for all medications.We received the following statement from Siri Nelson, President & CEO, Marshall Medical Center:Healthcare pricing, especially drug pricing, is extremely complex. Our hospital has tens of thousands of charge codes for medications, dosages and applications for use as well as various mark-up algorithms and this can lead to errors. A $2,000 tetanus shot is not acceptable. When issues are brought to our attention, we appreciate the opportunity to examine our process, apologize, and make corrections as necessary. We are taking the opportunity now to review our pricing approach for all medications. We don’t want access to basic medications to be cost prohibitive for patients. I want to thank those who have brought discrepancies to our attention so we can fix issues and learn how to improve the care and the experience we provide. We are partners with our patients in their health and wellbeing.I also want to share that if patients receive a bill and they have questions about it, they can call the hospital’s financial counselor. Financial counselors assist with helping patients apply for insurance coverage or offer other resources such as discount pricing and charity care.We also reached out to Spurry’s insurance to get to the bottom of the charge. Late Wednesday afternoon, a spokesperson from UnitedHealthcare said it “reprocessed the claim and she owed $0 for the tetanus shot under her plan,” which means, according to the spokesperson, Spurry will not have to pay anything for the tetanus shot.If people do get a surprise medical bill, UnitedHealthcare recommends the following:Try talking with the support staff at the hospital or doctor’s office to request having the charge waived or reduced.If needed, some health plans offer access to resolution support to help negotiate on behalf of members with hospitals and care providers.If you receive a surprise bill from an out-of-network care provider, do not immediately pay the bill. Call the number on your insurance ID card to alert your health plan and check on assistance.Again, Spurry did all of these things and even spoke with a financial counselor at the hospital who opened up a claim.”I don’t know what the outcome here is going to be. I’m not sure if what I’m doing is going to be effective,” Spurry said. “But certainly, ask questions. Call the insurance company, ask questions, call the hospital, ask them questions.”

TRUCKEE, Calif. —

We all know going to the emergency room will cost you big time, but a Northern California woman is facing serious sticker shock after seeing the breakdown of costs after a recent trip to the hospital.

The most expensive part of the bill wasn’t even the surgery but rather a tetanus shot. Kate Spurry of Truckee injured her foot as she was getting ready to go white-water rafting in the American River.

“Literally as we were packing the boats up the trailer fell on my foot so I didn’t ever even get in the water,” Spurry said. “I had broken my foot and there was a bone sticking out. It was pretty obvious I needed the nearest ER.”

Spurry said her friends and family rushed her to Marshall Medical Center in Placerville where she underwent surgery. There, she said she received great care as they stitched her up, and gave her antibiotics and a tetanus shot before sending her on her way with some crutches and a cast.

That is when the headache started.

Spurry showed KCRA 3 Investigates’ Brittany Johnson a copy of her Medical Explanation of Benefits from her insurance company, which stated the cost of her tetanus shot was $2,180.63.

Spurry said she was “flabbergasted” when she opened up her bill.

Her insurance, under UnitedHealthcare, said it would cover some of the costs but noted that Spurry was responsible for $1,251.89.

“It was more than the actual procedure,” Spurry said. “The actual procedure, which you can see here says surgery, is actually — I felt like that was a pretty good deal — that was a little over $1,300. So why would a shot that took about 10 seconds to administer, be twice that of a procedure that took well over an hour?”

In shock, Spurry said she called the hospital several times to try and make sure her bill was correct.

“The gal that I spoke to said, ‘Nope, that’s correct. Emergency care is always more expensive.'”

At her wit’s end, Spurry contacted us for help.

We called around to various pharmacies to inquire about the cost of a tetanus shot before insurance and found the cost was anywhere from $60-$80.

KCRA 3 sent Spurry’s information to Marshall Medical Center, along with a series of questions.

After our inquiries, the hospital said “A $2,000 tetanus shot is not acceptable,” and it is now reviewing its pricing approach for all medications.

We received the following statement from Siri Nelson, President & CEO, Marshall Medical Center:

Healthcare pricing, especially drug pricing, is extremely complex. Our hospital has tens of thousands of charge codes for medications, dosages and applications for use as well as various mark-up algorithms and this can lead to errors. A $2,000 tetanus shot is not acceptable. When issues are brought to our attention, we appreciate the opportunity to examine our process, apologize, and make corrections as necessary. We are taking the opportunity now to review our pricing approach for all medications. We don’t want access to basic medications to be cost prohibitive for patients. I want to thank those who have brought discrepancies to our attention so we can fix issues and learn how to improve the care and the experience we provide. We are partners with our patients in their health and wellbeing.I also want to share that if patients receive a bill and they have questions about it, they can call the hospital’s financial counselor. Financial counselors assist with helping patients apply for insurance coverage or offer other resources such as discount pricing and charity care.

We also reached out to Spurry’s insurance to get to the bottom of the charge. Late Wednesday afternoon, a spokesperson from UnitedHealthcare said it “reprocessed the claim and she owed $0 for the tetanus shot under her plan,” which means, according to the spokesperson, Spurry will not have to pay anything for the tetanus shot.

If people do get a surprise medical bill, UnitedHealthcare recommends the following:

• Try talking with the support staff at the hospital or doctor’s office to request having the charge waived or reduced.
• If needed, some health plans offer access to resolution support to help negotiate on behalf of members with hospitals and care providers.
• If you receive a surprise bill from an out-of-network care provider, do not immediately pay the bill. Call the number on your insurance ID card to alert your health plan and check on assistance.

Again, Spurry did all of these things and even spoke with a financial counselor at the hospital who opened up a claim.

“I don’t know what the outcome here is going to be. I’m not sure if what I’m doing is going to be effective,” Spurry said. “But certainly, ask questions. Call the insurance company, ask questions, call the hospital, ask them questions.”

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