Call Kurtis: Surprising Surgery Bill

ORANGEVALE (CBS13) — An Orangevale retiree says she says she was assured she'd pay just $69 for knee surgery, then was surprised to get a bill for more than $2,000. So she decided to call Kurtis.

Pamela Durocher is a breast cancer survivor. She's been dealing with health bills for a couple years now. When she recently needed knee surgery, she thought she knew how much she'd end up paying. So, why was she surprised to get the bill?

"I was walking my dog one day, I was about two blocks from the house and on the way back, I took a step and had a sharp pain and kind of took a few more steps and went, 'What the heck?'" said Durocher.

Just like that, Durocher had torn her meniscus, a cartilage cushion between the leg bones. She needed surgery.
"They went in right here and right here," said Durocher, showing her faint scars from the procedure.

She says both her doctor and insurance company assured her she'd only have to pay $69 for the procedure, which was the remainder of her out-of-pocket max. But the night before her operation, she says her doctor's office called, moving the surgery from the Mercy San Juan Surgery Center to the main hospital, which is three blocks down the road. She says she was assured once again it would only cost $69. But afterwards, a bigger bill showed up.

"They've billed just under $31,000 and they're saying my out of pocket is $2,051," said Durocher.

She learned those three blocks cost her big, because having the surgery at the main hospital sent her over her well over her insurance cap.

If the surgery had been performed at the original surgery center, her insurance tells us she would have only paid that $69.
"I burst into tears actually," said Durocher.

"It really does not seem like rocket science," says Amy Bach, Executive Director of United Policyholders.

Bach, a consumer advocate, says you should be able to know the out of pocket expenses before a medical procedure.

"The whole key is that the consumer has to be given information in advance of a charge being incurred, so that they can make an intelligent decision to protect themselves," said Bach.

CBS13 wanted to know who made the switch and why? Durocher's provider, Summit Orthopedics tells us, "We do not have clear records stating why the switch."

But in a letter Durocher obtained, they cite a "lack of surgical equipment available."

After CBS13 got involved, Durocher says mercy San Juan ended up writing off the remainder of her bill.

She has recovered from the knee injury but is leery of future health procedures.

"I don't know what I could do a whole lot differently, I mean I will probably even ask further questions," said Durocher.