Woman Taken to 'Wrong' Hospital Faces Bankruptcy

Woman Taken to ‘Wrong’ Hospital Faces Bankruptcy

by Adam Schrager - Channel 3000

Health • November 2014 • Views: 1,645

A project manager for a manufacturing company, she is one year removed from a cardiac arrest and the subsequent physical recovery is being dwarfed by a near-impossible fiscal recovery. She was sent last Sept. 9 to the emergency room at St. Mary’s Hospital, which was out of her insurance network, instead of to Meriter Hospital, three blocks away, which was covered by her insurance. It’s the difference between a $1,500 maximum out-of-pocket expense and the now-$50,000-plus she’s facing in bills.

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

More: Woman Taken to ‘Wrong’ Hospital Faces Bankruptcy

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10 comments

Skip Intro Nov 12, 2014 9:09:34am

Obviously this is her fault for not actively managing her healthcare choices.

Eclectic Cyborg Nov 12, 2014 9:34:00am

Completely appalling. Emergency services should be exempt from network restrictions, does it not make sense that a person in serious need of emergency services simply be taken to the CLOSEST FUCKING HOSPITAL?!

EiMitch Nov 12, 2014 10:22:57am

re: #2 Eclectic Cyborg

Hospital exec: What was that? My apologies. I couldn’t hear you. I was too busy snorting cocaine from the naked back of a $1000 p/h prostitute. Oh well. I’m sure you and my lobbyist can sort this out, whatever it is.

Dark_Falcon Nov 12, 2014 5:54:35pm

What’s really shocking is this part:

In Rothbauer’s case, her insurer, Blue Cross Blue Shield, said it paid St. Mary’s 100 percent of its in-network rate or $156,000 to cover part of the original $254,000 bill that she incurred during 10 days in a medically-induced coma and another six days in the cardiac unit. St. Mary’s negotiated with Rothbauer to reduce the remainder of her $98,000 bill by 90 percent. This is separate from the bills she received from the doctors, the ambulance, the therapist and others.

I’m pretty sure that the costs charged weren’t the one’s really incurred, but were instead just put out there as things to be bargained down from by insurance companies. But when this sort of coverage failure happens, normal people can just plain get chewed up by it.

klystron Nov 12, 2014 5:56:23pm

What’s shocking is that people don’t look at this story and see why it absolutely justifies the need for single payer.

Dark_Falcon Nov 12, 2014 6:13:58pm

re: #5 klystron

What’s shocking is that people don’t look at this story and see why it absolutely justifies the need for single payer.

IMO, that wouldn’t be much better, because the problem at the heart of either approach is that the entity handling the payment of Ms. Rothbauer’s massive expense incurred for treatment would be a bureaucratic entity. As such, said entity, whether private or governmental, is going to be largely hidebound and inflexible. And that’s mostly because the costs of treating a major cardiac arrest are so high that whoever is paying is going to look for ways to cut costs, and cost-cutting usually involves either cutting care quality (mostly done by single-payer, but sometimes by private companies as well) or shuffling the costs off on someone or something else (which is almost exclusively done by private entities).

I may be wrong about some of what I’ve said, and I admit I’m only gliding along the surface of a very complex problem. But this is my read of the situation, as best as I can figure it.

EPR-radar Nov 12, 2014 6:30:08pm

Moar blessings of Prosperity Gospel Jayzuz riding in on his Golden Bull Market. This is an obviously sensible result from the best health care system in the world (before Obamacare messed it up by getting rid of pre-existing condition arbitrage opportunities).

lostlakehiker Nov 12, 2014 10:28:23pm

re: #4 Dark_Falcon

What’s really shocking is this part:

I’m pretty sure that the costs charged weren’t the one’s really incurred, but were instead just put out there as things to be bargained down from by insurance companies. But when this sort of coverage failure happens, normal people can just plain get chewed up by it.

How about a narrow fix? Not every problem should be addressed in all its variety.

“No one is responsible for the excess cost of care over and above what they’d have incurred in-network if they ended up out of network through no decision or fault of their own.” Of course, this would have to be fleshed out with solid, weasel proof boilerplate.

Let the respective insurances sort it out from there.

Dark_Falcon Nov 12, 2014 10:56:09pm

re: #8 lostlakehiker

How about a narrow fix? Not every problem should be addressed in all its variety.

“No one is responsible for the excess cost of care over and above what they’d have incurred in-network if they ended up out of network through no decision or fault of their own.” Of course, this would have to be fleshed out with solid, weasel proof boilerplate.

Let the respective insurances sort it out from there.

That’s got a good bit of merit.

EiMitch Nov 13, 2014 8:14:24am

re: #4 Dark_Falcon

re: #6 Dark_Falcon

I’m pretty sure that the costs charged weren’t the one’s really incurred, but were instead just put out there as things to be bargained down from by insurance companies. But when this sort of coverage failure happens, normal people can just plain get chewed up by it.

Uninsured people getting screwed by chargemaster rates is a nasty wound. But the salt rubbed on it is that insurance companies and healthcare providers used to barter their prices up from medicare rates. But now healthcare is so consolidated that insurance companies have too little (if any) leverage to do that now. Instead they barter down from chargemaster rates. ACA does next to nothing to address this key problem.

And that’s mostly because the costs of treating a major cardiac arrest are so high that whoever is paying is going to look for ways to cut costs, and cost-cutting usually involves either cutting care quality (mostly done by single-payer, but sometimes by private companies as well) or shuffling the costs off on someone or something else (which is almost exclusively done by private entities).

Or we can just outlaw chargemaster practices. We can adopt a price-fixing practice similar to medicare. Apply it to healthcare providers as well as all healthcare supply manufacturers such as, to name two examples, pharmaceuticals and diagnostic tools. Adjust these rates once a year. Meanwhile, if there is a sharp rise in material costs, such as metal, then subsidize the difference. Problem solved, single-payer or not.

How can we do this in a free market? Trick question, you can’t. Instead, we should acknowledge what this linked story proves: that a free-market in healthcare isn’t possible, even in theory.

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