Phoenix veteran charged $4,500 he didn't owe for ER visit

Army veteran Gene Holliday knew he had to get to a hospital fast.

He had absent-mindedly struck his head on the metal corner of his porch awning, and the gouge in his scalp was bleeding badly. The blood thinners Holliday takes for a heart condition increased the risk.

"It's dangerous because I can bleed out real fast," Holliday, 58, said, recalling the incident last January. "If I don't get it sewn up or taken care of, I can have a problem."

Driving to the Phoenix VA Health Care System, where he usually goes, would take at least 20 minutes, he said. HonorHealth John C. Lincoln Medical Center was less than five minutes away.

The VA generally covers veterans' emergency care at private hospitals if it is necessary, so the decision of which hospital to visit was a no-brainer, he thought.

But during the next seven months, the visit and its resulting $4,576 billing mishap would cost him frustration and hours on the phone, Holliday said. He contacted The Arizona Republic's Call For Action volunteers for help.

HonorHealth spokesman Craig Kartchner said the company's billing department spent hours working to resolve the problem for Holliday and granted a longer grace period to his case because it was so complicated to deal with the VA.

"We don't have a contract with VA, which makes it difficult in situations like this to figure out payment," Kartchner said.

VA officials did not immediately return a request for comment. 

Surviving a bomb in Germany

Holliday drove a truck for the U.S. Army carrying nuclear warheads when he was stationed in Germany in 1979, he said.

He was injured along with hundreds of others in 1980 by a right-wing bomber at an outdoor Oktoberfest in Munich. His nose and hand were broken, his body was scarred and he still deals with post-traumatic stress, Holliday said.

Now Holliday lives in Phoenix and works in pest control.

CALL FOR ACTION SUCCESS:Couple gets help after cruise line strands them

VA denies hospital claim

After emergency-room staffers cleaned and dressed his head wound last year, Holliday thought he was in the clear.

Little did he know his bill would bounce between HonorHealth and VA for months.

HonorHealth submitted the claim in February soon after the emergency room visit, Kartchner said, but VA denied it in April because of a wrong address.

HonorHealth faxed a corrected claim the next day, but VA denied it in May as "not payable due to service not related," Kartchner said.

Such a designation likely means the medical care Holliday received was not related to injuries he sustained when he was in the Army.

FOR SUBSCRIBERS: Surprise couple gets $11,000 after storm damage

But VA policies make clear the agency will cover bills for emergency care at a private hospital for injuries unrelated to military service if:

• The veteran has been a VA patient in the previous two years.
• The VA hospital was not "reasonably available."
• A normal person would "reasonably believe that any delay in seeking immediate medical attention would cause their life or health to be placed in jeopardy."

Holliday thought his situation had met all three criteria, he said.

A bill for $4,576

HonorHealth went after Holliday to pay once the VA denied the claim.

The health care company sent him a bill in June for more than $4,576, Kartchner said.

"I got a call that the VA kicked it back because the billing wasn't coded right, and I got a bill," Holliday said. "I said, 'That’s not right. I shouldn't have to put up money because the VA is not handling it right or the hospital is not handling it right.'"

The bills and phone calls from HonorHealth were "nasty," Holliday said. He received a "final collection notice" that threatened to send him to a debt collector if he didn't pay.

"It's scary when you start getting phone calls that you're going to have bad credit, go to collections and have everything taken away from you," he said.

HonorHealth did not send Holliday's bill to collections, Kartchner said. The company actually put his account on a longer grace period because of the back-and-forth with the VA, he said.

But Kartchner acknowledged HonorHealth states on bills that patients who don't pay will be sent to collections.

As soon as Holliday got the bill, he called to ask HonorHealth to resubmit the claim to the VA, but the hospital company said that would likely result in another denial, Kartchner said.

Instead, HonorHealth suggested Holliday call the VA to find out the proper way to submit the claim. A few weeks later, HonorHealth also contacted the VA to discuss how to submit the claim and faxed new documents, Kartchner said.

Somebody to 'bounce ideas off'

By August, six months after Holliday's head injury, the claim still hadn't been satisfied.

Holliday felt he needed more help and talked to Call For Action at The Arizona Republic.

A volunteer advised Holliday to work with the VA to get a copy of a letter stating the agency would pay HonorHealth, even if the payment was in process and wouldn't be finalized for some time.

"It was calming to talk to him (the Call For Action volunteer) knowing he understands what you're going through," Holliday said. "It was somebody I could talk to and bounce ideas off of to get help."

Holliday obtained a preliminary notice from VA promising to pay $341 of the $4,576 bill. HonorHealth received a notice, too, Kartchner said.

Eventually, HonorHealth wrote off the rest of the bill, Kartchner said.

"We are focused intently on trying to simplify things for the patient, billing included," Kartchner said. "Health care billing in general is complicated, and with the VA, it's even more complicated."

FOR SUBSCRIBERS:They planned their dream home, but paid thousands for nothing

'You have to chase it down'

Holliday is relieved to put the billing stress behind him.

But he wishes the VA and private hospitals would work more smoothly together.

"The problem is (if a billing department makes a mistake), you have to do the legwork. You have to chase it down," he said.

He recommended veterans under VA care make sure to visit a private hospital for emergency care only when it's absolutely necessary and "stay on top of the billing," he said.

"I stood my ground on the whole thing," Holliday said. "Don't let it go off to the side."

FOR SUBSCRIBERS:Doctor's mistake left Phoenix veteran without birth certificate

Got a problem? Azcentral.com can help

Have you been scammed? Do you have a complaint against a business or government agency? If you live in Arizona, Call For Action and The Arizona Republic/azcentral.com can investigate. We're #HeretoHelpAZ.

The team so far in 2020 has saved consumers more than $21,000.

Fill out a form at heretohelpaz.azcentral.com, text HereToHelpAZ to 51555, or call 602-444-2255 from 11 a.m. to 1 p.m. Tuesday through Friday to talk to a Call for Action volunteer.

Consumer reporter Rebekah L. Sanders investigates issues of fraud and abuse involving businesses, health-care entities and government agencies. Contact her at rsanders@azcentral.com or follow her on Twitter at @RebekahLSanders. 

Support local journalism. Subscribe to azcentral.com today.