Deborah Buttgereit’s Unexpected Medical Journey

When Deborah Buttgereit collapsed outside her home in Bozeman, Montana, she immediately realized that a trip to the hospital was unavoidable.

“I could hear my bones moving in my elbow,” recalled the 60-year-old after slipping on ice last December.

An emergency room scan revealed significant damage to her left arm near the joint, and the doctor recommended surgery for repair.

At that point, Buttgereit didn’t have health insurance, having faced financial struggles following her husband’s passing. Bozeman Health estimated that Buttgereit would be responsible for around $50,560 out-of-pocket for what was categorized as an outpatient procedure.

According to those estimates, “If complications or special situations arise, additional charges may apply.”

Four days post-fall, Buttgereit underwent surgery that took about three hours. During a follow-up, her doctor mentioned that the surgery had turned out to be more complicated than initially anticipated.

Then came the bill.

Understanding the Medical Procedure

Buttgereit sustained a humerus fracture, the upper arm bone, which is relatively rare and represents only about 2% of all fractures in adults. Such breaks can be particularly painful and often hinder elbow movement, especially in older individuals and children engaged in high-risk sports.

While some fractures can heal with splints, surgery is frequently the required course of action. The patient is placed under anesthesia, and the surgeon must strategically reposition the fractured bone using a plate and screws.

Surprising Final Bill

The total bill came to $97,998, which included at least $44,300 for the operating room and anesthesia and over $50,000 for medical supplies like screws and plates. After applying a self-pay discount, Buttgereit was left with a shocking amount of $78,398.40 to cover.

Complications and Miscommunication

The hospital attributed the increase in Buttgereit’s surgical costs to unexpected complications encountered during the procedure.

Specifically, the surgeon noted that the fracture had splintered into more pieces than anticipated, requiring additional time, skill, and materials for reconstruction. Since Buttgereit was uninsured, she alone bore the financial burden for these increased costs.

“I’ll be paying this back for the rest of my life,” she lamented.

After losing her husband in 2023, Buttgereit left her job about a year later, feeling unable to cope with the reminders of her late spouse. This also meant losing her health insurance. She moved to Bozeman for proximity to her daughter and managed to secure a health plan through Healthcare.gov due to her limited income.

However, rising living costs exceeded her Social Security benefits, necessitating part-time work, and while this extra income helped with bills, she no longer qualified for the same health coverage she had previously received.

Just two months after losing her insurance, she experienced her unfortunate fall.

Upon receiving the surgical bill, Buttgereit reached out to the hospital’s customer service to understand how her estimated cost could rise from $50,560 to nearly $98,000. The hospital had automatically included a $19,600 discount for self-pay patients. Even with this, the remaining balance was still over $78,000.

Buttgereit sought more clarity, questioning why initial estimates seemed significantly lower than usual online figures for similar procedures.

She also inquired about how to formally contest the bill. Feeling frustrated with her lack of progress in disputing the charges, she explored options under the Federal Consumer Protection Act.

An email obtained by KFF Health News revealed that Bozeman Health employees misinformed her that the law pertained solely to emergency room services. An employee later corrected this by stating that she was entitled to dispute her bill, albeit with an incorrect deadline.

Hospital representatives suggested that Buttgereit set up a payment plan and apply for financial aid.

A spokesperson for Bozeman Health explained that online estimates don’t fully represent specific patient care circumstances, citing additional complications that justified the higher costs.

Pursuing Alternatives

Buttgereit opted to challenge what she deemed inflated charges instead of accepting financial aid. Utilizing an online price comparison tool, she discovered that costs for comparable procedures ranged from $8,000 to $40,000.

She felt the complications didn’t warrant the final price of her bill.

“Accepting financial aid felt like admitting I was okay with the bills,” she stated, expressing a desire to advocate for equitable pricing.

In May, billing staff offered her an additional $7,000 discount if she established a payment plan. They also assured her that if she qualified for financial aid later, the amount would be adjusted.

By June, a staff member informed her that her account would be placed on hold before any collections began “to give her time to decide.” Buttgereit agreed to a $100 monthly payment but continued to contest the bill.

If the hospital charges interest, it could take her around 60 years to pay off the debt at that rate.

Seeking further assistance, Buttgereit reached out to the White House.

This month, while grappling with the letter from the hospital that detailed the charges, she received a call from a representative at the Centers for Medicare and Medicaid Services, informing her of her right to challenge the bill.

Taking Action

The best moment to question prices is before surgery when hospitals provide estimates for potential costs. Otherwise, agreeing to surgery may imply consent to accept that price.

Patricia Kelmer, director of a national consumer advocacy group, encourages patients to seek and compare cost estimates actively. Although not all procedures have clearly listed prices, it’s advisable to research similar services in nearby hospitals.

Post-surgery, patients often have limited options for addressing substantial bills, but the No Surprise Act enacted in 2022 offers some protection against unexpected charges for out-of-network emergency care, potentially aiding self-pay patients facing non-emergency costs significantly above estimates.

Buttgereit initially hesitated to pursue formal disputes against her bill after such a review. However, after insights from CMS, she plans to move forward with that process.

“You have to fight for yourself,” she remarked. “I’m not sure where this path leads, but I feel a bit more hopeful.”