Maxwell Kruzic experienced severe stomach pain on October 5, 2023, which prompted him to seek emergency care at Mercy Regional Medical Center in Durango, Colorado. "It was the worst pain of my life," Kruzic said. Hospital staff suspected appendicitis and quickly began treatment, including an IV and a scan. However, tests revealed no issues with his appendix or abdomen.
Doctors considered other diagnoses such as kidney stones or gallstones but found nothing conclusive. When asked about his recent meals, Kruzic shared that he had eaten tacos with homemade hot sauce made from scorpion peppers—among the world's hottest peppers. He described them as "the world's hottest, incredibly hot," and added, "Delicious." Though he regularly enjoys spicy food without issue, this particular meal proved too intense for his digestive system.
Kruzic spent several hours in the ER before being discharged with medication for nausea and vomiting. Consuming extremely spicy foods can inflame and irritate the digestive tract; however, these symptoms usually resolve without intervention.
During his ER visit for acute abdominal pain, Kruzic underwent blood work and a CT scan. The total bill was $8,127.41—including $5,820 for the CT scan. He paid $97.02 at the time of service; after insurance adjustments through UnitedHealthcare and discounts, he was left owing $2,460.46 due to deductible and coinsurance requirements.
Nearly two years later—in September—Kruzic received a bill related to his 2023 hospital visit. There are no standardized rules requiring hospitals to send bills within a specific timeframe.
Anticipating a charge, Kruzic monitored both the hospital’s online portal and UnitedHealthcare’s site for updates on what he owed. For months after treatment—and despite assurances from UnitedHealthcare that if the hospital showed no balance due then none existed—the billing section indicated "$0."
The delay appears tied to ongoing disputes between Mercy Regional Medical Center's parent company CommonSpirit Health and UnitedHealthcare over payment amounts for services rendered.
Lindsay Radford Foster of CommonSpirit Health explained: "United Healthcare, the insurer responsible for the medical claim, underpaid the account based on the care provided. As a result, CommonSpirit contacted UnitedHealthcare's Payer Relations Department to rectify the underpayments." She attributed part of the delay to organizational changes at UnitedHealthcare.
UnitedHealthcare spokesperson Caroline Landree disagreed: "This was paid accurately."
Kruzic expressed frustration with receiving such a late bill: "Receiving a bill two years after the service wouldn't fly in any other industry. We could never contact a client two years after we completed a project and say, 'By the way, we missed this charge.'" He also questioned whether this situation amounted to surprise billing: "How could this be considered anything but surprise billing?"
The federal No Surprises Act mainly protects patients from unexpected out-of-network charges during emergencies or when visiting in-network facilities; it does not cover all situations where patients receive delayed or unexpected bills.
Maxwell Mehlmen of Case Western Reserve University School of Law commented on Kruzic's case: "The bill certainly sounds outrageous," adding that its legality depends on state law as well as insurance contracts between providers and insurers.
In Colorado regulations require Medicaid claims within 120 days of service; private insurance timelines depend on individual contracts between providers and insurers rather than state mandates.
If claims are filed properly by providers who continue negotiating payment in good faith with insurers—even over extended periods—patients may still be billed their share years later.
After KFF Health News contacted Mercy Regional Medical Center regarding Kruzic’s case—a call came informing him that his balance would be adjusted to zero due to clerical error following insurer delays in payment processing.
Radford Foster said that because UnitedHealthcare took so long to pay properly: "Kruzic's statement balance 'was to be adjusted to zero,' but due to a clerical error, a statement was sent to the patient in error." Landree confirmed: "Mr. Kruzic will not be responsible for any additional costs related to this bill."
KFF Health News’ “Bill of the Month” series receives annual reports about delayed “ghost bills,” often caused by prolonged negotiations between hospitals and insurers or post-payment audits leading patients—or their families—to face unexpected charges long after treatment concludes.
Ultimately whether such delayed billing is legal hinges largely on contract details rather than consumer expectations or fairness standards; an insurer stating that a claim is “processed” does not guarantee final resolution or payment agreement.
Despite these events—and his ongoing appreciation for spicy foods—Kruzic said he would avoid using scorpion peppers again: “I will not use scorpion peppers again.”
“Bill of the Month” is an investigative project by KFF Health News and The Washington Post’s Well+Being section which has helped many patients address medical billing issues since its launch in 2018.
