BAYONNE, N.J. (PIX11) — It’s never a good thing to have to be in a hospital emergency room. But for a single dad from Bayonne, his son’s ER visits became a more painful ordeal – once he saw the bills.
It all started in November when 3-year-old Devin Nicoletti took a fall and badly cut his chin. The babysitter called Devin’s dad, Vinny, at work. Vinny rushed home. And he did what most of us would do; take the child to the nearest emergency room. This one was at Bayonne Medical Center.
“Did anybody tell you that this is out of network when you were in the ER?” I asked Vinny.
“No,” Vinny said. “I didn’t know it wasn’t in network. You know I didn’t do the research. I got a phone call…”
Howard: “You just take him to the closest hospital.”
Howard: “It’s an emergency. You’re not thinking about what’s in network and what’s not.”
A few days later Vinny brought his son back to get the stitches removed. And a little after that, he finally checked his insurance benefits.
“I was like, this is outrageous…I mean at first I was a little shocked, you know. I thought there was a discrepancy.”
Why the outrage?
The total combined billing from the physicians and the hospital was $14,107.09!
Bayonne medical center’s portion alone was the bulk of it, more than $12,000.
That’s just for four stitches being put in and then removed.
Vinny couldn’t believe it. That’s why he contacted me.
“I don’t think I’ll be able to get it resolved and actually [have them] not charge me the money because I know at the end of the day the working class guy loses. That’s the way it’s always been.”
Howard: “It doesn’t have to be that way. It doesn’t have to be that way. That’s kinda why I’m here.”
Vinny: “Yeah, I’m hoping that possibly you can help me out.”
When we started looking into it, we found that under New Jersey law, the billing is completely legal. Not only that, but under the law, Vinny’s insurance company is obligated to pay the bill!
Ultimately, a little was knocked off, but the insurer paid the hospital more than t$10,400! And Vinny still owed the hospital another $828.21 out of his own pocket!
Bayonne Medical Center is a for-profit hospital owned by a private corporation, Carepoint Health Medical Group. According to the President of the New Jersey Association Health Plans, Ward Sanders, Carepoint uses the Emergency room as a profit center.
“The business model is to drive folks through the emergency room door.”
Sanders explained that the idea behind New Jersey’s policy was to make sure that people forced to go to an ER outside of their insurer’s network won’t get stuck with huge out-of-pocket bills. That’s why the insurance company must pay the charges.
“If you access an emergency room [New Jersey law] says the insurer has to pay to make sure the consumer is treated as if they are in network…so at some facilities you have these really inflated charges that bear no resemblance to the cost of providing the service.”
Sanders says that’s what Bayonne Medical Center is doing.
We made numerous requests to have Bayonne Medical Center give us an interview. But in the end, all we got was a brief statement attributed to Carepoint’s General Counsel that accused us of trying to make “an effort to create a sensational news story.” There was no response to the substance of the story.
The hospital did respond to Vinny. After we got involved, the hospital reduced his out-of-pocket expense to $250.
Vinny was grateful.
“I’m happy and I’m very satisfied that you guys came out and helped me.”
“That’s what we’re here for,” I told him.