Drew's $100,000 Heart Attack

Drew didn’t know it but he was about to enter the world of balance billing.

Managed care can quickly become mangled care without warning. First created by Congress in 1973 as part of the HMO Act. By the early 80′s the practice of incentivizing and directing care to “preferred” providers was going mainstream.

The idea of saving money on health care by encouraging those with health insurance to use more “cost effective” avenues of health care may have seemed benign at first but as this monster grew it became punitive.

In the case of Drew Carver, this is what happened.

St. David’s Healthcare, part of the HCA system, is not a participating provider in Drew’s health plan. Most health care plans have allowances for out of network bills incurred as a result of a life threatening illness or injury. Many times the non-par penalty is waived by the health care plan and the provider agrees to accept a “reasonable” offer as “paid in full”.

That did not happen in this case.

St. David’s stuck to their guns and refused to budge. It did not matter that such a large unpaid bill could cause serious financial harm to Mr. Carver.

The hospital wanted what they felt like was a fair price for saving Mr. Carver’s life.

In fact, the hospital had the nerve to blame the Austin School District for offering such “a narrow network product placed a large portion of the financial responsibility directly on the patient because our hospital was not in-network.”

Frankly I am surprised the hospital didn’t also blame Drew for having the heart attack at an inconvenient place. Had the attack occurred closer to a participating hospital this would never have been a problem for Drew or St. David’s.

Then there is this . . .

Industry analysts and consumer advocates say St. David’s has a reputation for exorbitant billing and for trying to collect big payouts as an out-of-network provider. “This is a well-known, problematic provider. We’ve seen multiple bills from them and they are always highly inflated,

“Always” is quite a damning term but if the shoe fits . . .

A few states, including Texas, have passed laws designed to protect insureds against balance billing. 

So why didn’t the law protect Drew?

Roughly 70% of people turning 65 have coverage through an employer health insurance plan. The linked article claims 60% of those plans are self funded.

That’s a lot of folks left out in the cold in situations experienced by Drew Carver.

For all this turmoil and angst it seems there is a happier ending, albeit one that came as a result of public shaming.