When the hospital tried to bill her for more than what she'd been quoted, Tiffany Qiu refused to pay the extra amount and the bill went to collections. She still didn't back down.



We have in hand another baffling medical bill. We investigate one such bill each month with the help of Kaiser Health News. And Dr. Elisabeth Rosenthal, who's editor in chief of Kaiser Health News, is with us once again. Good morning.

ELISABETH ROSENTHAL: Thanks for having me.

INSKEEP: So whose bill are we investigating this month?

ROSENTHAL: This month, we're talking to Tiffany Qiu. She's a mom, a wife. She lives in Southern California. And she had a relatively straightforward procedure, did all her homework and spent a lot of time trying to figure out what she would have to pay.

INSKEEP: I'm guessing, since we've brought this bill here, that things did not work out as she had expected.

ROSENTHAL: And you are so right (laughter).

INSKEEP: Well, let's hear the story then. It comes from Dan Weissmann, host of the podcast "An Arm And A Leg," who talked with Tiffany to find out what happened.


DAN WEISSMANN: Tiffany Qiu took every precaution. Before committing to a minor surgery at a local hospital, she called for an estimate. And when the hospital said her share after insurance would be 20% of the bill...

TIFFANY QIU: I said, did you talk to my insurance company? You need to double-check that.

WEISSMANN: She knew her policy said she was supposed to pay 30%. They said they were sure. She called back a couple days later to ask again, said, I talked to my insurance. They said 30%. Hospital was like, no, no, really, 20%. It seemed too good to be true.

QIU: But I asked them twice. And this a big hospital. I said, OK.

WEISSMANN: Day of surgery, the hospital wants to be paid up front, which is a surprise. She drills them.

QIU: Is this all I have to pay? Will there be any other surprise for me?

WEISSMANN: And she makes sure to get a receipt. And then later, she gets a bill - $933.87, which is the difference between the 20% she's already paid and the 30% her insurance would usually expect her to pay. She's like, well, I got receipts - calls them and calls and calls. This was last November, last December. Then...

QIU: In May, I suddenly received this collection letter. Wow, collection - my first time.

WEISSMANN: She considered just paying it, she could've.

QIU: I said, no, no, no. I'm not paying it because this is not right.

WEISSMANN: Tiffany does not love this kind of thing - the calls, the emails, the confrontation - but she does it. And she keeps her guard up. When she sends a written dispute letter to the collection agency, it's certified mail. And when they don't respond, she calls, says, hey, your letter says I'm supposed to hear back within 30 days. They say, nope, the law gives us 60 days.

QIU: I said, really? I'm not a lawyer. But your letter says you will get a response within 30 days.

WEISSMANN: They say, whatever, it's 60. Call back later. And when she does, they say, oh, we've sent it to the hospital. I guess they're looking at it.

QIU: Nobody can give me a very clear answer. What's going on? Who is in charge? Where the case is? Nobody knows.

WEISSMANN: And then Tiffany gets lucky. A reporter gets interested in her case, makes a call to the hospital. Suddenly, after that one phone call, Tiffany is hearing from a hospital executive with an apology.

QIU: That phone call just magic, solved everything in one hour - not just one day, but one hour.

WEISSMANN: Taking this road was harder for her. And it's not something she would have done when she arrived in the U.S. from China at age 26.

QIU: I have changed a lot - how to see the world, how to do things, how to fight (laughter), including this (laughter). I've learned from my kids about U.S. history and politics. And I agree there is something we can do, everybody can do. They need to give pressure to the system to change a little bit over time so that it can get better.

WEISSMANN: As a proud U.S. citizen, she's doing her bit. For NPR News, I'm Dan Weissmann.

INSKEEP: And Elisabeth Rosenthal of Kaiser Health News is still with us. And, Elisabeth, I want to start by noting that she knew what the price would be at the beginning and tried to pay it. They wouldn't let her at the beginning. This is one of the most remarkable parts of this.

ROSENTHAL: Well, Tiffany was offered something called forgiveness of copayment, which we've all heard. You know, a doctor or a hospital will say, oh, we'll just take what your insurance pays us. And then you don't have to pay anything or only a small portion of what it says you should. Sounds like a great offer, right? But, in fact, it's illegal under insurance contracts. So when a doctor or a hospital gives you that kind of special offer, alarms should go off.

INSKEEP: So this is, perhaps, how she ended up with what seemed like a bargain. Then the bargain turned against her. And she definitely did not let go at that moment.

ROSENTHAL: Right. So when the alarms go off, the first thing you should say is, give me this in writing from the hospital or from the doctor, not from some clerk over the phone. And then, when they can't follow through on the bargain, at least you have something on paper to argue with.

INSKEEP: How significant is it that everything magically changed within hours when the media got involved?

ROSENTHAL: We see this a lot. But to me, it's really a condemnation of our system. You know, the only way to get your bills resolved is you have to go to a national reporter and get on radio and TV. That's really wrong, isn't it?

INSKEEP: It's tempting to draw another lesson from that, which is that companies could get it right the first time. And do you suspect that some choose not to because there's more money in it and many people just will humbly pay?

ROSENTHAL: Sure. The first lesson from the Bill Of The Month series is don't just write the check. You know, health care institutions come in all stripes. Some are honest, some are not. And many will try and get away with whatever they can, even if it's technically legal or unfair to patients. And I think we all have to learn to be Tiffany and fight back.

INSKEEP: If you had an opportunity at any point in this process to give advice to Tiffany Qiu, what would you have said?

ROSENTHAL: Well, she was a great fighter. But I would have said, get it in writing. Get it in writing. And if you know your insurance contract says 30% and someone is telling you, don't worry, we'll take nothing or 20%, don't believe it.

INSKEEP: Elisabeth Rosenthal, thanks, as always.

ROSENTHAL: Thank you.

INSKEEP: And if you have a bill you'd like us to look over, go to NPR's Shots blog and send it.