Just look at what happened to Drew Calver. As Kaiser Health News reports, when the 44-year-old teacher suffered a massive heart attack (what they call a widow-maker) in April 2017, he was rushed to the nearest hospital, St. David’s Medical Center in Austin. Calver, who was insured by Aetna, expressed concern that his treatment would not be covered because St. David’s was out of network, but hospital staff reassured him it would. Well, they turned out to be wrong.
Care delivered for the four-day hospital stay, which included four stents being inserted in his clogged artery, totaled $164,941. Aetna, Calver’s insurer, paid $55,840. Calver was billed $108,951.31. The hospital’s billing company sent Calver a notice on June 26 telling him that this was his final opportunity to pay up.
Calver tells KHN: “They’re going to give me another heart attack stressing over this bill. I can’t pay this bill on my teacher salary, and I don’t want this to go to a debt collector.”
As is the case with other tears in the health care safety net, this is something that some states are trying to mend. Texas, New York, New Jersey, and California have passed laws that try to shield patients from surprise bills, which usually occur when hospitals and insurers cannot agree on what’s a fair price for delivered care. But those laws don’t apply to people, like Calver, who work for a self-insured employer. Federal law oversees those plans, and it doesn’t include that fix.
KHN: “About 60% of people with employer health benefits are covered by self-insured plans, but many don’t even know it, since employers typically hire an insurer to administer the plan and employees carry a card bearing the name of Blue Cross Blue Shield or another major insurer.”