WOOSTER, Ohio — Has this happened to you? You go in for a medical procedure or treatment thinking you're significantly covered by insurance but, turns out, you're not. One local man is stuck with a hefty bill in the muddy waters of hospitals, insurance, and a past employer.
"It's not easy at all. It's like a very slow root canal,” said Alan Sands. The root of his problem was an on-going fever back in 2018. At times it hit 103.
"I just couldn't break it,” said Sands. “It was at nighttime and I would wake up in the middle of the night (and my clothes) would be just absolutely soaked."
He went to the emergency room at Wooster Community Hospital. Doctors then put him in the ICU.
"They ran the whole panel from soup to nuts to try and figure out exactly what I had,” Sands said. Sands said he was in the hospital for about a week, recovered for another week at home, then went back to work.
The hospital sent bills to Sands totaled nearly $15,000. However, he was confused. He said a year or two prior to the fever incident, he went to the ER because of a possible heart attack. He said the hospital took his insurance then, but the fever bill was basically all passed on to him.
"How is this even possible when you have insurance and you have out of pocket deductibles," he questioned.
Sands said he called his employer at the time Tenable Protective Services, a self-insured company. "(They told me), ‘Don't worry about it. We'll take care of it. That's definitely not what you owe. So, don't worry about it," said Sands.
He called Wooster Community Hospital.
"It's the hospital that is putting the bill out, so, we'll go ahead and we'll contact the insurance company for ya and basically leave you out of it," said Sands.
He called his employer's third-party administrator Alternative Risk Management AKA Alt-Risk that handled insurance claims. "The insurance company would say, ‘Don't worry about it. We'll contact hospital on your behalf and we'll work it out,” said Sands.
“So, it was a constant circle of people supposedly contacting each other?” we asked.
“Correct,” said Sands.
He authorized Wooster Community Hospital to talk to us.
It "declined an on-camera interview." It also said it "has no contract with Alt-Risk.
"$15,000. I just don't have it in my pocket to turn around and give somebody,” Sands said.
The hospital said when it accepted his insurance previously for things like lab work, those smaller amounts were overlooked. Well, Sands feels overlooked and baffled.
"Does any of this make sense to you?” we asked Sands.
“If did make sense, I wouldn't be here (doing this interview) trying to make sense of it," he replied.
At one point, Sands said he asked for an audit of his bills. “Her response was, 'If we have to go back and do an audit, then I'm going to re-open every single one of your accounts. And if we find that we made any mistakes or if any mistakes were made as far as not billing you, we will turn around and bill you for every penny.’” Sands told us.
Sands said he felt threatened by that. "A hospital is saying, 'Hey, you know what? If you're going to make us go through the work, we're going to pound you with every penny...at that point wouldn't you be afraid and you would just pay the money?" he questioned.
Wooster Community Hospital said it doesn't think that came up in conversations with him.
"She said…’If you should be mad at anybody, it should be with your insurance company,’" Sands said.
We contacted Tenable Protective Services. It referred us to Alt-Risk. Alt-Risk refused to answer our questions. Sound familiar?
"Somebody's not telling the truth,” said Sands. “And that's the principle of it. That's what needs to come out."
Sands also suggested that if you feel you have a good argument about charges but you're getting denied by various medical entities, continue to fight. Exhaust every appeals process and don't just pay because they say you should.
More on News 5's Diagnosis Debt series here.