This NJ woman spent 6 years fighting a $225K hospital bill. Here's how it ended.

When Seiko Bando was taken to Christ Hospital in Jersey City in 2016 after an exam revealed heart problems, she received both a pacemaker and a bill that is the stuff of health care nightmares: $225,187.

The 65-year-old accountant spent almost seven years fighting the bill with a financially strapped hospital chain that for years had some of the highest charges in the nation and had focused on out-of-network bills as a business strategy.

On Friday, after NorthJersey.com contacted the hospital for comment, Christ Hospital administrators told Bando that her bill was waived.

"I'm so shocked, in a great way," Bando said. "It’s a great relief. I can’t really explain it. I spent so many sleepless nights trying to get this resolved, and now it is.”

Despite the happy outcome, Bando's case represents a perfect storm of everything that can go wrong with health care finances: an under-insured patient who doesn't qualify for Medicaid or charity care getting emergency treatment at a hospital that at the time was part of a for-profit chain that charged extraordinarily high prices.

Phil Swibinski, a spokesman for CarePoint Health, which includes Christ Hospital, Hoboken University Medical Center and Bayonne Medical Center, said the chain has undergone "a significant transformation," since it is now a nonprofit enterprise and an in-network provider with all major insurance carriers.

"We sympathize with Ms. Bando for experiencing a significant medical event and for any impression she may have had that this debt was still active, and we hope that she can now move forward secure in the knowledge that she does not have any outstanding obligations," Swibinski said in a statement.

But the journey to get there was long and difficult.

Taken to the emergency department

Bando said she has been in good health her entire life. But in late 2016, she began feeling overly fatigued. Having been late for an annual checkup, she scheduled one at a doctor’s office in Jersey City’s Journal Square on Nov. 2, 2016. At the time, Bando was 57, single and making $20 an hour at a temp agency reviewing tax and regulatory forms for clients.

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At the doctor’s office, the staff said her heart rate was extremely low and was surprised she had not fainted. They conducted an electrocardiogram twice on Bando to confirm the results. The office called an ambulance, and Bando was taken to Christ Hospital’s emergency department — where a cardiologist said she needed a pacemaker.

“I was really surprised,” she said. “As far as I was concerned, I was functioning normally. I kept asking, ‘Do I really need a pacemaker?’”

The surgery was performed the next morning with no complications, and a day later Bando was discharged.

Bando said no one at the hospital spoke to her about her insurance coverage or the costs of the procedure. She said she went about her daily life normally until April 2017, when she received a bill from CarePoint showing that her insurance had paid only $600.

She was responsible for the remaining $224,587.

More than 100 itemized charges

An itemized bill for Bando’s time at Christ Hospital shows more than 100 charges, for everything from medicine and blood tests to emergency room treatment and surgery.

The biggest charges were $39,837 to implant the pacemaker and $36,000 for the pacemaker itself. The national average for the procedure under Medicare is about $11,000 in a hospital outpatient setting, according to the Centers for Medicare & Medicaid Services.

But the bulk of Bando’s bill was not for the actual surgery. It was for 54 hours of “observation,” for which the hospital charged $2,072 per hour, for a total of $111,888.

“It was so outrageous I thought it was obviously a mistake,” she said. “I soon found out it wasn’t.”

Thus began years of trying to negotiate the bill down and navigating the bureaucracies of the hospital, an insurance company and government agencies.

Bando said Christ Hospital staff said her income was too high for her to qualify for charity care — the state program that provides free or heavily discounted hospital services for those with low income.

Swibinski said Friday that CarePoint had not "attempted to collect on Ms. Bando's bill since May 2017." But a collection agency working for the hospital did try, according to a 2019 bill sent to Bando from Paragon Revenue Group.

Under scrutiny by state investigators

While Bando was fighting the case, CarePoint was the subject of much scrutiny.

In 2019, the owners of CarePoint were cited by state investigators for taking $158 million in “management fees” over several years by relying on high out-of-network billing in emergency departments as a business model to boost revenues. Of that, $30 million came from Christ Hospital, $99 million from Bayonne and $29 million from Hoboken University Medical Center, said the State Commission of Investigation report.

Bando's insurance company — American Public Life — told her in letters that she had only a "limited hospital indemnity plan" — a supplemental benefit plan that is not considered major medical insurance. The $600 was the proper payment based on the plan, the letter said.

The New Jersey Department of Banking and Insurance said in a letter to Bando that it could not assist her because her type of plan was not covered under state insurance laws.

Bando was eventually referred to Adria Gross, a medical insurance advocate who helps negotiate hospital bills on behalf of patients. But even she had a difficult time trying to lower the bill.

She lobbied Christ Hospital, local politicians, state agencies and even the U.S. Department of Labor, which told her it had no jurisdiction over hospital prices.

"This is the worst I’ve ever seen," Gross said before Christ Hospital waived the bill Friday. "They won’t budge. If this went to court, no judge would side with them because they couldn’t even afford it. It’s ridiculous."

CarePoint has struggled financially

CarePoint has been struggling financially. The company has been sued by about two dozen creditors since early 2023 seeking $11 million, The Jersey Journal reported.

In December, CarePoint asked state leaders for $130 million, saying it was needed to continue operations at its three hospitals. It even started an online petition two months ago to drum up support for its request. As of Friday morning, the petition had 1,702 signatures out of a goal of 2,500.

"CarePoint has not received nearly the amount of state funding for these types of uncompensated care that would allow it to operate at a sustainable pace," Swibinski said of Bando's case. "As a system that operates safety net hospitals in urban areas, our commitment to the community is absolute, and we always strive to serve the needs of Hudson County."

On Friday morning, the billing department at Christ Hospital confirmed that Bando's bill was still active and she owed $224,587. NorthJersey.com contacted Swibinski with this information.

About an hour later, Justin Drew, a vice president at CarePoint, told Bando and Gross that the bill was waived. "This email is to confirm that Seiko Bando doesn’t have a balance owed to Christ Hospital," he wrote.

A few hours later, Bando and Gross met for the first time face-to-face in front of Christ Hospital to discuss the case. But it became more of a celebration, with the two women hugging each other after the years-long ordeal ended.

"It took up so much of my life," Bando said. "You spend so much time, so much energy calling people, trying to make this right. So it isn't just relief that I feel now. It feels like my life has changed."

This article originally appeared on NorthJersey.com: NJ woman was charged $225K for 3-day hospital stay. She fought it