Wisconsin woman fights $23,000 bill for knee surgery

GLENDALE, Wis. - A Glendale woman thought her surgery would be covered by insurance. Then, she got a bill for $23,700.

United Healthcare (UHC) and The Midwest Orthopedic Specialty Hospital (MOSH) give conflicting explanations as to how it happened. 

Surgery not covered by insurance?

The backstory:

Kristine Staral usually enjoys a test of stamina, as owner of The Exercise Coach in Brookfield. Her passion for fitness does more than pay her bills; it helped her to recover quickly from knee surgery.

"I feel like a lot of what I've done in my life to keep healthy and strong helped me," said Staral.

The Injury 

What we know:

 Back in July, a friend's rottweiler rammed into Staral's leg, breaking her tibia just below the knee joint. 

"The pain was excruciating," said Staral. "I instantly went down to the ground and realized something pretty bad happened."

Four difficult days later, Staral rolled out of surgery at MOSH in Franklin with a plate in her knee.

MOSH is a partner of Ascension.

Unexpected bill

Dig deeper:

Staral recovered from the surgery faster than her doctors predicted. Then, came the shocking bill for $23,700 after insurance.

"That set me on the course of trying to figure out what happened, why it wasn't covered," said Staral.

Fighting the denial:

UHC said Staral's surgery was out-of-network and no valid authorization had been approved.

Staral appealed the decision, providing two letters from the Orthopedic Institute of Wisconsin in Wauwatosa. One letter states the "medical necessity" of Staral's treatment.

The second letter states that UHC did authorize the procedure one day before Staral's surgery, while speaking with the Orthopedic Institute of Wisconsin over the phone.

"I've got the proof that it was covered," said Staral. "I just feel like United Healthcare is fighting a battle with me and I don't know why."

Seeking out help

What you can do:

 After Staral's appeals were denied, she wrote to Contact 6 in February. The consumer segment began emailing with Ascension and UHC on her behalf.

Staral also contacted attorney Justin Wallace of Wallace Law. Last week, he filed a lawsuit against UHC.

"I think if any insurance company isn't going to pay for a procedure like this, they should be very upfront," Wallace told Contact 6.

Resolution:

It looked like Staral's case was headed to court. Then, Staral got a call from Ascension.

"(The woman) explained to me that they are obviously very frustrated for me," said Staral. "They are going to take all responsibilities off my shoulders for the bill."

That means Staral no longer has to pay it.

What they're saying:

A MOSH spokesperson tells Contact 6 it apologizes to Staral for the inconvenience. Its spokesperson says that MOSH did get authorization for the surgery.

In a statement, MOSH says that UHC initially denied the request as out-of-network but then approved a one-time exception.

"When the claim was subsequently processed, the authorization was not applied as expected by UHC," said the MOSH spokesperson.

The statement said MOSH has "resubmitted the claim" and is "continuing to work directly with UHC to resolve the matter."

It's now up to MOSH and UHC to debate the charges, which Staral says is a relief. 

The other side:

UHC denies that Staral's authorization for the surgery was approved.

"The authorization was denied because the provider is not in network per Ms. Staral's health plan ... The provider proceeded with the surgery on July 17, 2025, without an approved authorization."

UHC said it "remains open to negotiation to resolve these charges."

The Orthopedic Institute of Wisconsin did not respond to Contact 6's request for comment.

Why you should care

What we know:

 It's been a test of endurance unlike any this trainer has faced.

"I think it really was (Contact 6's ) help to be honest with you," said Staral of MOSH's decision. "I think you guys got their attention."

Staral hopes other policyholders won't buckle under the pressure of insurance denials.

"If anybody else has to go through this, all I can say is, "you have to advocate for yourself," said Staral.

Full response from UHC

• Ms. Staral’s health plan does not include out-of-network coverage for this procedure.
• A prior authorization for Ms. Staral’s surgery was submitted and received by UHC on July 16, 2025. The authorization was denied because the provider is not in network per Ms. Staral’s health plan. Several other local providers were shared. Letters were mailed to Ms. Staral and her provider on July 17, 2025, the day following the prior authorization submission.
• The provider proceeded with the surgery on July 17, 2025, without an approved authorization.
• We have been and remain open to negotiation to resolve these charges on behalf of Ms. Staral.

Full statement from MOSH

"We are committed to helping patients navigate the billing process and recognize that these situations can be complex. When a physician determined the patient’s surgery was necessary, the physician’s office pursued authorization with the patient’s insurance carrier.

"UnitedHealthcare (UHC) initially denied the request due to an out-of-network designation. An appeal was submitted, and UHC approved a one-time gap exception. When the claim was subsequently processed, the authorization was not applied as expected by UHC.

"We resubmitted the claim and are continuing to work directly with UHC to resolve the matter.

"Importantly, regardless of the insurance resolution, we have determined the patient is not responsible for these charges. The patient’s financial responsibility is zero, and all previous payments related to this charge are being refunded. Refunds typically take 7 to 10 business days.

"We apologize for the inconvenience and are focused on ensuring prompt resolution.

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