Sometimes, the best way to identify a problem is to see it through someone else’s eyes. Take, for example, the British media coverage of the plight of a U.S. woman who was taken to the “wrong” hospital when she suffered a heart attack. The Wisconsin woman now faces bankruptcy because of her medical bills.
How is this possible, the incredulous reporter for The Telegraph wonders?
Megan Rothbauer suffered a serious heart attack at work last September. The then-29-year-old was unconscious when an ambulance arrived. It took her to the closest hospital.
But that hospital was not in the network covered by Rothbauer’s insurer.
The result? Rothbauer was left with $52,531.92 in bills for her care, which included 10 days in a medically induced coma, The Telegraph’s David Milward reported. If the ambulance had gone three blocks farther to a hospital in Rothbauer’s insurer’s network, the bill would have been capped at $1,500.
This situation “highlighted the complexity of the American health insurance system,” Milward wrote. In America, you have to stay in your insurance network, even when facing an emergency and, in Rothbauer’s case, unable to speak and tell an ambulance what hospital to go to.
The hospital where Rothbauer was treated, St. Mary’s, was actually very accommodating. Its total bill for her care was $254,000. Her insurance company, Blue Cross-Blue Shield, agreed to pay $156,000, the rate it would pay to an in-network hospital. St. Mary’s then wrote off 90 percent of the remaining hospital charges. Rothbauer still has to pay bills from doctors, therapists and the ambulance — which were outside the Blue Cross network. These charges totaled more than $50,000.
An unnamed spokesperson for the insurance company said the company wouldn’t pay more “since we have no contract with this hospital, we have very little influence over what the hospital is charging in this situation,” The Telegraph reported.
Likewise, Rothbauer had little influence over where she ended up for her medical care. Yet she now bears a heavy financial burden for her care simply because she was taken to a hospital that didn’t have a contract with Blue Cross-Blue Shield. Rothbauer, by the way, doesn’t really blame anyone for what happened. Instead, she is focused on finding ways to pay her bill, including delaying her wedding and considering bankruptcy.
For Meg Gaines, head of the Center for Patient Partnerships, a consumer advocacy group at the University of Wisconsin-Madison Law School, “This brings the health care problems to a pinnacle. The question is, will we tolerate this as a society?”
That is the question. Reform work, like the Affordable Care Act, has eliminated some of the most egregious health insurance discrimination, such as denying policies to people with pre-existing conditions. Steering patients to providers with better outcomes and negotiating lower prices are important steps in reducing America’s high health care expenses.
But cases like Rothbauer’s show that reliance on a system heavy on bureaucracy and inflexible policies leaves people with health insurance vulnerable to falling into unexpected gaps in coverage when an emergency strikes.