Colorado Doctor Hit With $64,000 Surprise Bill After Ankle Surgery, Exposing No Surprises Act Loopholes

The Irony of the $64,000 Hospital Bill

In a stark illustration of the labyrinthine complexity of the American healthcare payment system, even medical professionals are not immune to financial shock. Dr. Lauren Hughes, a physician based near Denver, Colorado, found herself battling her insurer and a major hospital system after a sudden car accident in February 2025 left her with a broken ankle and a staggering hospital bill of approximately $64,000.

Dr. Hughes’s experience—moving from caregiver to patient—highlights critical ambiguities and potential loopholes in the federal No Surprises Act (NSA), legislation designed specifically to shield consumers from such unexpected costs. Despite her professional knowledge and attempts to secure coverage beforehand, the physician was ultimately held liable for the massive charge following an overnight stay and necessary surgery at a UCHealth facility.

The Accident and the Critical Care Decision

The incident occurred when Dr. Hughes was T-boned by another driver while heading to a clinic about 20 miles from her home. The resulting injury—a severely broken ankle—required immediate surgical intervention.

Faced with a critical need for specialized care, Dr. Hughes chose a UCHealth facility. While the surgeon she used was in-network with her insurer, Anthem Blue Cross and Blue Shield, the hospital facility itself was designated as out-of-network (OON).

Understanding the financial risk, Dr. Hughes attempted to secure a single-case agreement (SCA) with Anthem prior to the procedure. An SCA is an ad hoc contract that treats a specific patient’s care at an OON facility as if it were in-network, often used when specialized or geographically convenient care is necessary. Dr. Hughes believed she had received verbal confirmation from Anthem that such an agreement was in place, justifying her choice of the closer, specialized UCHealth facility over an in-network option, such as HealthONE’s Presbyterian/St. Luke’s Medical Center, which was reportedly 20 miles further away.

The Single-Case Agreement Controversy

Following the surgery and overnight stay, the claim was submitted. Anthem subsequently denied the claim and refused to honor the alleged SCA, arguing that the facility was OON and that Dr. Hughes should have sought care at an in-network hospital. This denial left Dr. Hughes facing the full brunt of the $64,000 bill—a classic case of balance billing, where the provider charges the patient the difference between the billed amount and what the insurer paid (in this case, zero).

Why the No Surprises Act Fell Short

Signed into law in 2020 and effective in 2022, the No Surprises Act (NSA) was a landmark piece of legislation designed to prevent patients from receiving surprise bills for emergency services or for non-emergency services provided by OON clinicians at an in-network facility (like an OON anesthesiologist at an INN hospital).

Dr. Hughes’s situation, however, fell into a complex gray area that exposed limitations in the NSA’s scope:

• Planned Procedure at OON Facility: While the injury was the result of an emergency, the surgery itself was a planned procedure. Crucially, Dr. Hughes knew the facility was OON, even if she believed she had secured an SCA.
• The Definition of Unforeseen: The NSA primarily protects patients when they unknowingly receive OON care. Because Dr. Hughes was aware of the facility’s OON status, even with the alleged SCA, the core protections were difficult to apply.

The Independent Dispute Resolution (IDR) Ruling

When insurers and providers disagree on payment under the NSA, the dispute is sent to the Independent Dispute Resolution (IDR) process. This mechanism is intended to resolve payment disagreements without involving the patient.

In this case, the dispute centered on whether Anthem should pay UCHealth for the services rendered. The IDR process ultimately sided with the provider, UCHealth. This ruling meant that the NSA protections were deemed inapplicable, leaving Dr. Hughes, the patient, responsible for the full $64,000 charge.

“The fact that I, a physician who understands the system and tried to do everything right, still got tripped up by this massive bill, shows how broken the system remains for the average person,” Dr. Hughes stated, underscoring the systemic failures.

Broader Implications for Patients and Policy

Dr. Hughes’s case is a powerful example of how the intricacies of insurance contracts and regulatory definitions can override a patient’s best efforts to comply with the system. It demonstrates that even with federal protections in place, patients can still be caught in the middle of provider-insurer disputes, particularly when single-case agreements are involved or when the line between emergency and planned care is blurred.

Key Challenges Highlighted by the Case:

1. Verbal Agreements vs. Written Contracts: Relying on verbal assurances from an insurer regarding an SCA proved disastrous. Patients must insist on written confirmation for any OON treatment agreement.
2. Facility vs. Provider Network Status: The NSA often addresses OON providers working at INN facilities. This case flips the script, showing the vulnerability when an INN provider works at an OON facility, especially if the patient is deemed to have had alternative INN options.
3. IDR Process Limitations: While the IDR is meant to shield patients, if the IDR determines the NSA does not apply to the specific claim, the patient is often left holding the bill, forcing them into a separate, often protracted, negotiation with the provider.

This incident serves as a crucial warning for consumers across Colorado and the nation: securing care, even for a serious injury, requires meticulous verification of both the physician’s and the facility’s network status, preferably in writing, before receiving treatment.

Key Takeaways

Dr. Hughes’s battle against the $64,000 bill offers essential insights into the current state of healthcare billing and the limitations of consumer protection laws:

• The Bill: Dr. Lauren Hughes received a bill for approximately $64,000 for ankle surgery and an overnight hospital stay at a UCHealth facility following a car accident in February 2025.
• The Dispute: The bill arose because the facility was out-of-network with her insurer, Anthem Blue Cross and Blue Shield, which denied the claim and an alleged single-case agreement (SCA).
• NSA Failure: The federal No Surprises Act did not protect Hughes because she was deemed aware of the facility’s OON status, and the procedure was classified as planned surgery, not an unforeseen emergency service at an in-network site.
• IDR Outcome: The Independent Dispute Resolution process sided with the provider (UCHealth), leaving the patient liable for the full amount.
• Action Taken: Dr. Hughes is currently appealing the IDR decision, highlighting the ongoing legal and financial struggle.

What’s Next

Dr. Hughes’s appeal of the IDR decision is ongoing and could set an important precedent regarding the application of the NSA in cases involving attempted single-case agreements and OON facilities. For now, she remains in negotiation with UCHealth to resolve the debt.

This case has galvanized consumer advocates and policymakers in Colorado, prompting renewed scrutiny of how insurers handle SCAs and how the IDR process interprets the definition of “surprise” billing under the federal law. Until these ambiguities are clarified, patients, even those with deep knowledge of the system, must remain vigilant against the threat of massive balance bills.