(Newser) – Drew Calver, 44, survived a heart attack last year only to be hit with a bill that, he tells NPR, could practically “give me another heart attack”: St. David’s Medical Center in Austin, Texas, said the teacher owed $108,951.31—almost double his annual salary. St. David’s is out-of-network on his school district health plan, but the hospital assured a concerned Calver it would accept his insurance. The total bill for a surgery to implant stents in his clogged artery plus four days in the hospital came to $164,941; his insurer paid $55,840 and the hospital billed him for the rest. As NPR explains, two practices known as surprise bills and balance billing often come into play in cases like this:
- Surprise bills: A person goes to an in-network hospital, but receives treatment from an out-of-network doctor while there and ends up with a bill from that doctor.
- Balance billing: An insurer agrees to pay for the necessary emergency care at an out-of-network hospital if it’s the closest one, but then disagrees with the hospital on a reasonable price. The patient is then billed the difference.
Texas is one of several states with laws aimed at helping to protect consumers from such practices, but the protections don’t apply to those whose employers self-insure—and about 60% of people who are covered by employer health insurance plans, including Calver, are indeed covered by a self-insured plan and may not even know it. See NPR for more, including experts who say Calver’s total bill was significantly more than it should have been, but the bottom line is that after the article was published, St. David’s said Calver could apply to see his balance reduced to $782.29.
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