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Jennifer Talavera thought she did everything right when was expecting twins.
She confirmed she had insurance coverage at the time of delivery and delivered at an in-network hospital. Still she wound up with a huge medical debt.
When inspecting the mounds of bills she received, she realized she was being asked to pay a lot more for one twin than the other.
“I owe $252,000 for my son’s claims and for my daughter right now I have a balance of $90,000,” Talavera said.
She has spent the first four years of her twins’ lives fighting those bills. She has a $343,000 hanging over her family’s heads for Parker and Juliette’s treatment.
“I mean that’s a large balance,” Talavera said. “Our dream is to buy a home and how can you buy a home if you have a balance like that and grow as a family.”
The twins were delivered during an emergency C-section and were delivered by the same doctor and spent time in the same NICU with similar issues.
The twins arrived home a week apart after roughly two months in the hospital.
Talavera was initially billed more than $200,000 dollars for each child’s treatment.
Her insurance provider was willing to cover $132,000 toward Juliette’s charges but only $33,000 for Parker.
“Complete anxiety, stress, how am I gonna handle this, you know, thinking about my children, putting them through school, how can I afford to do that,” Talavera said.
Talavera says when she asked about the difference, she was told her twins were treated by different doctors in the NICU. She was told Juliette was mostly treated by an in-network physician and Parker mostly by one out-of-network.
“I never would’ve chosen an out-of-network doctor for one child and an in-network doctor for the other. So I don’t even understand how that could’ve even happened,” Talavera said.
Talavera filed an appeal with her insurance provider and worked with a medical advocate but says nothing changed.
In June, she called NBC 6 Responds.
“I’m feeling helpless right now, I don’t know what to do anymore and I need help,” Talavera said.
We looked at the twins’ bills. We found the same doctor was coded as in-network one day, but out-of-network the next. That means Talavera could have been given different charges for the same treatment.
The twins were treated at an in-network hospital, but they were treated by doctors who were part of a physician group that was out-of-network at the time the twins were in the NICU.
In a statement, the parent company for the physician group told us “Pediatrix Medical Group of Florida, Inc., an affiliate of MEDNAX, acquired certain assets of South Dade Neonatology in October 2018. This affiliation was subsequent to the time when Ms. Talavera received care. At the time that care was rendered, South Dade Neonatology was out-of-network with United Healthcare at Baptist Hospital. This matter was recently brought to MEDNAX’s attention and we worked towards finding a resolution with United Healthcare for Ms. Talavera. Today, South Dade Neonatology is in-network with United Healthcare and it has agreed to reimburse the practice. As of June 28, South Dade Neonatology will no longer bill Ms. Talavera, and she has been informed that she will not be responsible for anything additional. We consider this issue resolved.”
We also reached out to Talavera’s insurance provider United HealthCare. A spokesperson told us “We’re sorry for the difficulty Ms. Talavera experienced. We have resolved this matter with the physician group and the Talavera family no longer owes anything more than they have already paid under their benefit. We will continue to work with hospitals and health care providers to avoid surprise medical bill issues when out-of-network providers deliver care at in-network facilities.”
With $343,000 of medical debt gone, the Talavera family is now free to move forward with peace of mind.
“The greatest thanks of all to NBC 6 for listening to my story and helping me with this battle,” Talavera said.