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Insurance mix-up causes problems for Greensboro boy in need of surgery

Ian Gillespie doesn't get all the medical mumbo-jumbo. What he does know is that he needed surgery to feel better. Unfortunately, an insurance issue is delayed it.

GREENSBORO, N.C. — Sitting around a giant coffee table full of more than 1,000 puzzle pieces, Ian Gillespie and his brother try to connect the puzzle. The two boys get excited when they find a piece that fits. The puzzle will most likely take a week if not longer to build, which is still far less than the mess Ian’s parents are dealing with.

The issue is centered on a medical problem Ian had more than a year ago. Ian has a somewhat rare medical issue that included surgery and follow-up procedures.

“He has some digestive issues that will really affect him his whole life,” his dad, Jason Gillespie, said.

The recent surgery was designed to aid in his overall health, but others would need to follow up a short time later. The surgery went well, and the family was gearing up for a second procedure soon when they received a bill from their insurance provider for almost $7,000.

“We were not prepared for certainly the biggest portion of this to not be covered,” Gillespie said.

The family had previously spoken with their doctor and the insurance company. They were under the impression that the procedure was mostly covered by insurance.

“This is not a new procedure. Certainly not for this specialist. It is done all the time,” Gillespie said.

The next several months were spent talking with representatives from the doctor’s office, the insurance company, and Gillespie’s HR department. Gillespie requested a review and an outside appeal, but it didn’t make a difference, the insurance company said the bill needed to be paid.

The unpaid bill has also delayed any future surgeries because the family can’t afford another massive bill.

“It’s been a nightmare,” Gillespie said.

After trying to get the issue resolved for close to a year, Gillespie reached out to News 2 in hopes we could assist.

“I thought it would not hurt to see what you could do,” Gillespie said.

We initially reached out to the doctor’s office and spoke with a representative. We then contacted the insurance provider in hopes of understanding what was going on. A corporate team member told us it would review the case and get back to us.

After a few additional calls and emails from us, the insurance company contacted Gillespie about the situation. A representative told him the bill was due to a coding issue and would be corrected and the charges covered.

“(He) just said the whole thing was a mix-up between EOB (explanation of benefits) and what was billed by the hospital,” Gillespie said.

It’s still a bit unclear as to why the mix-up wasn’t caught earlier, but at least it was resolved. The family no longer had to worry about a massive unpaid bill or debt collectors calling.  

“I’m just glad we able to get some answers from this and it took coming to you to get this resolved,” Gillespie said.

The only downside in all of this is the time wasted. Ian did not have a follow-up surgery because of this and the doctor who performed the surgery has since moved out of state. The family is now having to kind of start over with a new doctor and a new plan of care.

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