An uninsured Montana woman received a medical bill for nearly $98,000 after undergoing surgery for a broken arm, a figure that was almost double the initial estimate provided by the hospital. The case highlights the financial risks for uninsured patients and the complexities of navigating hospital billing systems, including a little-known provision in federal law designed to protect them.
Key Takeaways
- Deborah Buttgereit, a 60-year-old uninsured woman, was billed $97,998 for surgery on a broken arm after an accidental fall.
- The hospital's initial good faith estimate for the procedure was significantly lower at $50,560.
- The hospital attributed the price increase to unforeseen complications, including a more severe fracture and nerve damage discovered during the surgery.
- After contesting the charges, Buttgereit learned about a dispute process for uninsured patients under the federal No Surprises Act, which she plans to use.
An Unexpected Fall and a Financial Shock
In December, Deborah Buttgereit, 60, slipped on a patch of ice outside her Bozeman, Montana, apartment. The fall resulted in a severe injury to her left arm. "I could hear the bones moving around in my elbow," she recalled, knowing a hospital visit was unavoidable.
Emergency room imaging confirmed she had a distal humerus fracture, a complex break of the upper arm bone near the elbow joint. Doctors informed her that surgery was necessary to properly repair the damage.
The Challenge of Being Uninsured
Buttgereit found herself without health insurance after a series of difficult life events. Following her husband's sudden death in 2023, she left her job, and with it, her health coverage. She later secured a subsidized plan through the federal marketplace but had to drop it when a new part-time job increased her income just enough to make the plan unaffordable.
Understanding her financial vulnerability, Buttgereit requested a cost estimate from the provider, Bozeman Health. The hospital provided a "good faith estimate" of $50,560 for the outpatient surgery. The document included a standard disclaimer that the final cost could be higher if complications arose.
The Soaring Cost of a Complicated Surgery
Four days after her fall, Buttgereit underwent a three-hour operation to reconstruct her elbow. During a follow-up appointment, her surgeon explained that the procedure had been more complex than anticipated. The full financial impact of these complications became clear when the final bill arrived.
The total charge was $97,998. The hospital had already applied a 20% self-pay discount of $19,600, but this still left Buttgereit responsible for a staggering $78,398.40.
Breakdown of the Charges
- Operating Room & Anesthesia: Over $44,300
- Medical Supplies & Implants: Over $50,000 (including plates and screws)
According to a spokesperson for Bozeman Health, the significant price increase was due to factors discovered mid-surgery. Operating notes revealed the bone had shattered into more pieces than initial scans suggested. The surgeon also identified and repaired nerve damage during the procedure.
"This situation highlights the importance of clear and compassionate communication," said Erin Schaible, a Bozeman Health spokesperson. She added that the hospital is revising internal protocols and reeducating staff on communicating cost estimate changes.
Navigating a Complex Billing System
Faced with a debt she saw as insurmountable, Buttgereit began the arduous process of questioning the bill. "I'll make payments the rest of my life to pay it all off," she said, determined to understand the drastic price jump.
She contacted the hospital's customer service department repeatedly, asking for a detailed justification for the charges. She also researched comparable procedures using online tools like Healthcare Bluebook, which showed a price range between $8,000 and $40,000 for similar surgeries, far below even her initial estimate.
Misinformation and Limited Options
Buttgereit's attempts to formally dispute the bill were met with confusion. When she inquired about her rights under the No Surprises Act, a federal law designed to protect patients from unexpected medical bills, she received incorrect information. According to emails, a hospital billing employee wrongly told her the law only applied to emergency room services and later provided an incorrect deadline for filing a dispute.
Hospital staff suggested she apply for financial assistance, but Buttgereit resisted. "I felt like going through financial assistance means that I’m OK with the price of the bill," she explained. "I want to get the bill reduced on the front end and then, if I need financial assistance, go through it."
The hospital eventually offered an additional $7,000 discount if she established a payment plan. She agreed to pay $100 per month to prevent the bill from going to collections but continued to challenge the total amount. At that rate, it would take over 60 years to clear the debt, without accounting for potential interest.
A Federal Lifeline for Uninsured Patients
Feeling she had exhausted her options with the hospital, Buttgereit took an unusual step: she emailed the White House to share her story. Shortly after, she received a call from an official at the Centers for Medicare & Medicaid Services (CMS).
The official informed her about a specific, and often overlooked, provision of the No Surprises Act. The law includes a formal patient-provider dispute resolution process for uninsured and self-pay patients whose final bill is at least $400 more than the initial good faith estimate.
How the Dispute Process Works
According to consumer advocates, this process is a critical tool for patients paying out-of-pocket. Patricia Kelmar, a director at the U.S. Public Interest Research Group (PIRG), described it as a "watchdog" for cash-pay patients. The process requires the following steps:
- The patient must initiate the dispute within 120 days of receiving the bill.
- The process is started online through the CMS portal and requires a $25 administrative fee.
- While under review, the bill cannot be sent to a collection agency.
- An independent reviewer examines whether the final price is fair compared to what an insurer would pay and if the complications were truly unforeseeable.
- If the reviewer sides with the patient, the provider may be required to lower the bill.
Buttgereit had initially been hesitant about this path, concerned that the lowest possible outcome would still be the original $50,560 estimate. However, after speaking with the CMS official, she decided it was her best course of action.
"You’ve got to fight for yourself," she stated. "I don’t know where this is going to end up, but I feel a little bit more hopeful." Her case serves as a powerful example of the financial perils facing the uninsured and the importance of understanding consumer protection laws in the complex world of American healthcare.
