Fully-Insured Woman Gets $50,000 Bill After Being Taken To ‘Out Of Network’ Hospital While In Coma

Here’s how a person can do everything right and still get royally screwed.

A Wisconsin woman who had gone into cardiac arrest was up to date on her insurance payments and fully covered and yet due to the infuriating ways health insurers and hospitals mismanage healthcare, she is now facing bankruptcy from a medical emergency beyond her control.

According to Wisconsin’s News 3, 30-year-old Megan Rothbauer suddenly went into cardiac arrest and was rushed to the hospital while unconscious. After doctors revived her and she was on the road to recovery, she got slapped with a bill so large that it’s surprising her still frail heart could take it: $50,000 out of pocket. The hospital she was staying at didn’t take her insurance. Even worse, another hospital, just three blocks away, did, but the ambulance didn’t take her there.

Speaking to News 3, Rothbauer says the decision to take her to the “wrong” hospital was completely out of her hands due to the whole, you know, almost dying thing:

“I was unconscious when I was taken to the hospital,” she said. “Unfortunately, I was taken to the wrong hospital for my insurance.

“I was in a coma. I couldn’t very well wake up and say, ‘Hey, take me to the next hospital.’ It was the closet hospital to where I had my event, so naturally the ambulance took me there. No fault to them. It’s unfortunate that Meriter is in network and was only three blocks away from St. Mary’s,” Rothbauer said.

The only sliver of good to come out of a truly maddening story is that thanks to new regulations implemented by the Affordable Care Act, her insurer, Blue Cross Blue Shield, had to pay its in-network rate for her care, saving her about $100,000 – yes, really.

Still, even with those “savings,” a $50,000 bill hanging over a person’s head is enough to leave nearly anyone financially destitute. Rothbauer, who had until recently planned on getting married soon, has no idea how she will pay back the money and is now facing bankruptcy. Blue Cross Blue Shield released a statement essentially saying it was all the hospital’s fault and there is nothing they can do about it.

“(Megan) received care by a hospital that is not in our Wisconsin network,” Scott Larrivee, public relations director for Anthem Blue Cross Blue Shield, wrote in an email to News 3. “Since we have no contract with this hospital, we have very little influence over what the hospital is charging in this situation.”

The hospital defended its actions by saying that they could have charged her more but didn’t. And while that may be technically true, that doesn’t really make the situation any better.

Medical experts who spoke with News 3 admitted that this kind of situation is probably pretty common. As anyone who has had to deal with the confusing, byzantine way in which healthcare works in America knows, there is almost no sense to what is covered, when things are covered, which doctors take what insurance, what hospitals recognize what procedures, and so on. It’s so complicated that one needn’t be in a coma to wind up paying thousands of dollars extra for services they thought would be covered by their insurance providers.

As we’ve seen, the Affordable Care Act can be a major help for bringing down the cost of care in America, but it only works if we begin to solve the intractable ways we implement insurance policies. No one should be making monthly payments for insurance only to be forced into bankruptcy by the margin of three city blocks.

h/t Gawker