A transgender woman who was told she would be charged $20,080 for prepaid gender confirmation surgery got a bill that was more than quadruple that amount from University of Wisconsin Hospital in Madison, reports Kaiser Health News.
The woman's request that her health insurer not be billed for the surgery also was ignored, Kaiser Health News reported.
Here are seven things to know:
1. Wren Vetens enrolled as a doctoral student at the University of Wisconsin-Madison in 2016.
2. At the time of her enrollment, she said the university offered insurance coverage for her gender confirmation surgery, according to the report. However, the state discontinued the coverage, and Ms. Vetens and her mother, a physician, shopped around for another plan.
3. After some research estimating the cost of surgery at $19,000 to $25,000, Ms. Vetens and her mother bought coverage from Consolidated Health Plans, which offered a maximum of $25,000 to cover the surgery. But months before the procedure, the hospital told Ms. Vetens the bill was estimated at $100,000, meaning her out-of-pocket costs could be up to $75,000 after insurance.
4. Once Ms. Vetens and her mother complained, the hospital agreed to accept $20,080 for the surgery without charging her insurance, as long as the amount was paid out of pocket and in full before the procedure, according to the report. Ms. Vetens said she was told the procedure would be canceled if the hospital didn't receive prepayment by the end of business on Dec. 21.
5. The payment was made, but Ms. Vetens later received a total bill for $91,850.20. The bill showed an insurance payment of $25,427.91. The $20,080 was deemed a deposit, and Ms. Vetens' remaining out-of-pocket costs were billed at $13,191.95.
6. Ms. Vetens' surgery was a case where the hospital and insurer were each working to determine her procedure's monetary worth, according to the report. A hospital spokesperson told KHN the hospital would base its price on how much the insurer would reimburse. At the same time, Consolidated Health Plans was waiting for a price from the hospital before determining coverage, its president and CEO said. Hospitals often inflate procedure costs because they know insurers will negotiate them down.
7. In the end, the hospital agreed to repay Ms. Vetens' insurance company, reports KHN, and after an appeal from Ms. Vetens and her mother, Consolidated Health Plans reimbursed Ms. Vetens nearly $18,000. The reimbursement, which countered the insurer's previous decision not to pay for care, dropped Ms. Vetens total surgery costs to about $2,100.
Read more about the case here.
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