Kruzic underwent blood work and a CT scan of his abdomen during his ER visit for acute abdominal pain.<\/p>\n
Consuming very spicy foods can cause<\/a> painful inflammation and irritation of the digestive system. The discomfort typically resolves on its own.<\/p>\n The Final Bill<\/strong><\/p>\n $8,127.41, including $5,820 for the CT scan. Kruzic paid $97.02 during his visit to the hospital, which was in-network under his insurance. After insurance payments and discounts, he owed $2,460.46 \u2014 the remainder of the $1,585.26 he owed toward his plan\u2019s deductible and $972.22 he owed in coinsurance.<\/p>\n The Problem: Ghost Bills From Visits Past<\/strong><\/p>\n This September, Kruzic received a bill for his pepper-induced ER visit in 2023.<\/p>\n Unfortunately for patients, there are no uniform rules for timely billing.<\/p>\n Anticipating a bill, Kruzic repeatedly checked the hospital\u2019s online portal, as well as that of his insurer, UnitedHealthcare. He noted that the insurer said the claim had been processed shortly after his treatment. For about eight months, he kept checking the hospital portal\u2019s billing section, which indicated he owed \u201c$0.\u201d He called UnitedHealthcare, and Kruzic said a representative assured him that if the hospital said he owed nothing, that was the case.<\/p>\n It is unclear what caused the nearly two-year delay. At least part of the problem seems to have involved protracted disagreements between the insurer and the hospital over how much his visit should have cost.<\/p>\n Lindsay Radford Foster, a spokesperson for CommonSpirit Health, the hospital system, said in a statement to KFF Health News: \u201cUnited Healthcare, the insurer responsible for the medical claim, underpaid the account based on the care provided. As a result, CommonSpirit contacted UnitedHealthcare\u2019s Payer Relations Department to rectify the underpayments.\u201d<\/p>\n Asked why it had taken two years, she cited a reorganization at UnitedHealthcare and a change in the insurer\u2019s representative assigned to the case.<\/p>\n But UnitedHealthcare contested that view. \u201cThis was paid accurately,\u201d said Caroline Landree, a spokesperson for the insurer.<\/p>\n But those explanations don\u2019t satisfy Kruzic, a geological consultant: \u201cReceiving a bill two years after the service wouldn\u2019t fly in any other industry. We could never contact a client two years after we completed a project and say, \u2018By the way, we missed this charge.\u2019\u201d<\/p>\n \u201cHow could this be considered anything but surprise billing?\u201d he added.<\/p>\n The federal No Surprises Act doesn\u2019t protect against all types of medical bills that patients find surprising. It primarily protects patients from out-of-network charges when they visit an in-network hospital, or in an emergency.<\/p>\n But in medical billing, what\u2019s legal and what\u2019s reasonable are two very different issues.<\/p>\n \u201cThe bill certainly sounds outrageous,\u201d said Maxwell Mehlmen, co-director of the Law-Medicine Center at the Case Western Reserve University School of Law. \u201cThe question is whether it\u2019s legal.\u201d<\/p>\n That, he said, \u201cis a matter of state law and the terms of the insurance policy and the agreement between the hospital and the insurer.\u201d<\/p>\n In Colorado, there are extensive regulations about how long health care providers have to file a claim and bill a patient<\/a>. For instance, claims for Medicaid patients must be filed within 120 days<\/a> from the date of service. For patients with private insurance, the terms may be outlined in their insurers\u2019 contracts with individual providers.<\/p>\n If a hospital submitted a proper claim<\/a> and the provider and insurer were working out payment in good faith, then a patient can be billed for their share of the costs years later.<\/p>\n The Resolution<\/strong><\/p>\n Within hours of KFF Health News contacting the hospital\u2019s media relations department for this article, Kruzic got a call from a hospital executive telling him his bill had been adjusted to zero.<\/p>\n Blaming administrative changes at the insurer, Radford Foster of CommonSpirit said that UnitedHealthcare had taken so long to properly pay the bill that the hospital couldn\u2019t collect from the patient. She said that Kruzic\u2019s statement balance \u201cwas to be adjusted to zero, but due to a clerical error, a statement was sent to the patient in error.\u201d<\/p>\n UnitedHealthcare\u2019s Landree said that \u201cgiven the significant delay, we are addressing this issue directly with the physician\u2019s office.\u201d<\/p>\n \u201cMr. Kruzic will not be responsible for any additional costs related to this bill,\u201d she said.<\/p>\n The Takeaway<\/strong><\/p>\n KFF Health News\u2019 \u201cBill of the Month\u201d series receives complaints every year about ghost bills \u2014 bills that arrive long after a service is rendered.<\/p>\n Sometimes it\u2019s because the insurer and hospital are haggling over payment, and the patient\u2019s responsibility \u2014 usually a percentage of that number \u2014 can\u2019t be calculated until the dispute is resolved<\/a>. Other times, insurers audit old bills and, determining they overpaid, try to claw back the money, resulting in the patient (or even the patient\u2019s surviving spouse<\/a>) being billed for the difference.<\/p>\n For now, the legality of billing long after treatment depends primarily on the fine print of insurance contracts.<\/p>\n An insurer\u2019s word that a claim has been \u201cprocessed\u201d doesn\u2019t mean that the insurer has agreed to pay and that the billing is resolved. It could also mean that the insurer balked at the bill or completely denied payment.<\/p>\n As for Kruzic and his affinity for hot peppers? He said he still loves spicy food, but in his cooking, \u201cI will not use scorpion peppers again.\u201d<\/p>\n Bill of the Month is a crowdsourced investigation by KFF Health News<\/a> and The Washington Post\u2019s Well+Being<\/a> that dissects and explains medical bills.\u00a0Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it<\/a>!<\/em><\/p>\n\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n![](\"http:\/\/www.dangeladvertising.com\/wp-content\/uploads\/2025\/12\/DEC_BOTM_Kruzic_15-resized-scaled.jpg\")
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