In September 2013, a Wisconsin woman went into cardiac arrest. The woman, Megan Rothbauer, was sent to the nearest hospital, St. Mary's, only to learn later that hospital wasn't covered by her insurance company. Now she's fighting a financial battle.
She told WISC, "I was in a coma. I couldn't very well wake up and say, 'Hey, take me to the next hospital.'"
It turns out Megan Rothbauer's insurer, Blue Cross Blue Shield, doesn't cover St. Mary's Hospital, but it does cover Meriter Hospital, which is just three-tenths of a mile away.
Rothbauer says if she'd been taken to Meriter, her maximum copay would have been just $1,500. That's not the case for St. Mary's. Rothbauer notes, "Currently the bill is $52,531.92."
This is about balance billing, which according to Healthcare.gov is "When a provider bills you for the difference between the provider's charge and the allowed amount."
That isn't to say Blue Cross Blue Shield hasn't helped Rothbauer out, though.
Her original bill was $254,000 for the 16 days she spent in the hospital. She told WISC the insurance company paid $156,000 of that total, which is the in-network rate. Rothbauer also says St. Mary's reduced the remainder of her bill by 90 percent. But she still has to pay the bills for the ambulance, the doctors and the therapist.
The public relations director for the insurance company told WISC, "Since we have no contract with this hospital, we have very little influence over what the hospital is charging in this situation."
But the EMTs in the ambulance were complying with Wisconsin state law when they brought Rothbauer to the nearest hospital. And St. Mary's seemed to be a solid choice.
Back in 2013, it was named one of the country's 50 top cardiovascular hospitals.
Rothbauer is currently at a standstill while she waits to hear back from her latest appeal to her insurance company. She hopes to negotiate with the hospital again to see if the doctor's bills can also be reduced.
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