Surgery overcharge: Chicago-area cancer patient charged $47K more than expected

CHICAGO (WLS) -- It can be an overwhelming feeling, getting slapped with a hospital bill that you don't believe you owe.

The ABC7 I-Team is investigating "surgery overcharge." A local man was billed $47,000 more than he should have been.

The south suburban man said he had his surgery pre-approved with the hospital and insurance. But then came the sticker shock and a surgery overcharge for a bill for eight times more than he thought. He called the I-Team for help.

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Lansing resident Joe Dubczak was relieved to know he beat prostate cancer, but he couldn't believe his eyes when he got this surgery bill for more than $53,000.

"It was a shock," Dubczak said. "And, you know, honestly, the surgery was easy and learning you have cancer is scary. But that whole process was easy. This has been ten times more stressful than the surgery itself and the recovery."

Dubczak thought his bill was going to be about $5,800, as noted on this initial document. He got the surgery pre-approved through Advocate South Suburban Hospital in Hazel Crest and Blue Cross Blue Shield of Illinois.

"Everything went as planned until a month after the surgery, when I got a bill for $53,500 plus," Dubczak said. "Right away I thought blue cross couldn't have seen this yet or they are sitting on it or something."

However, after making calls to the hospital and his insurance company, he found out that $53,000 was the final bill, and he had to pay up.

"And so the last five months now has been back and forth between Blue Cross and the hospital," Dubczak said. "Neither one of them wanting to fix this, although they both acknowledge something's wrong. So the hospital has been very aggressive at trying to get funds."

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He said when he wasn't getting answers, he called the I-Team.

"I just kind of gave up," Dubczak said. "And that's when I contacted [the I-Team]."

ABC7 emailed the hospital and the insurance company, sending them the documents showing Dubczak's pre-approved estimate and documents showing that he was only supposed to pay $5,800. Within weeks, Dubcazk got a call.

"The vice president of consumer affairs for the company that oversees advocate or health and apologetic, and we're working on this with Blue Cross," Dubczak said.

Weeks later, he got updated bills showing he now longer owes the extra money.

"I am so grateful that you were able to do this," Dubczak told the I-Team. "I don't know what you said in their email, but I really appreciate your help."

Neither the Advocate South Suburban Hospital or Blue Cross Blue Shield of Illinois commented specifically on the patient's case, but sent ABC7 the following statements.

Advocate said, "We are committed to guiding patients as they navigate and plan for the cost of their care, and we have a process in place to work with patients and insurers to resolve issues when appropriate."

Blue Cross Blue Shield of Illinois said "We are committed to putting members first and working with providers to help them receive appropriate, covered services. Anyone who has a concern about coverage should reach out to us at the number on their member ID card."

Dubczak never got a detailed explanation for the error, but said he was told by insurance that there was coding issue. Dubczak said the hospital was out-of-network, but he had an out-of-network waiver as part of his pre-approval.

"it's very stressful," Dubczak said. "And it's unacceptable."

Consumers should always carefully review all hospital bills. If there is a problem, fight the bill before sending any money.

You can formally dispute them with the hospital and insurance and collection agencies. If you can't get your issue resolved, you can also file a complaint with the Illinois Department of Insurance.