Ellen Gentile was already lying on the operating table with a hospital gown on and an IV in her arm when her family says they learned the neck surgery she believed had been approved might not be covered after all.
The Millburn, New Jersey mother had been living with what she described as excruciating pain from a ruptured disc that left her partially paralyzed and unable to move her arms or hands. Expecting long-awaited relief, she arrived at the hospital ready for the procedure after being told to come in the night before.
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"The night before they called me and told me, come on in," Ellen told ABC’s 7 On Your Side consumer reporter Nina Pineda (1). "You know, we assumed everything was approved."
With her condition worsening and mobility at risk, the surgery ultimately went ahead. But when the bills were later tallied, Gentile and her husband, Matthew, were left facing roughly $126,000 in medical costs.
However, what Ellen experienced isn’t uncommon. A 2024 study from the Commonwealth Fund found that nearly half of insured Americans have faced unexpected medical expenses (2). Here’s how the situation unfolded and what patients can do when coverage falls through.
When Pineda later sat down with the couple to trace where the breakdown may have happened, she asked whether anyone had warned them the procedure might not be covered.
"Well, the business director said this usually gets worked out," Matthew recalled.
After submitting their claim – which totalled six figures and included roughly $37,000 for an artificial spine device and about $9,000 in anesthesia costs – the couple was denied coverage. They went on to appeal the decision twice, but both attempts were unsuccessful.
When 7 On Your Side later contacted her insurance company, Independence Blue Cross, and provided letters of medical necessity from Gentile’s physician, the insurer maintained its position, citing that the device was not approved by the U.S. Food and Drug Administration and that the surgery had not been formally authorized. Still, the exchange revealed one remaining option: the couple could pursue a final review through an independent third party.
