Last September, Megan Rothbauer nearly died from a heart attack. After being picked up unconscious, paramedics followed protocol and rushed her to St. Mary’s Hospital in Madison – the closest hospital to their location.
There, Megan Rothbauer received the best care as doctors and nurses saved her life. She’s quick to lavish praise on the paramedics and hospital that saved her life. It sounds like a happy ending. She nearly died, but being close to a hospital saved her life.
If the story ended there, it would be that happy ending. Except, even with health insurance, Megan was hit with $300K in medical bills. It turns out that St. Mary’s is out-of-network for her health insurance plan, managed by Blue Cross Blue Shield. And St. Mary’s, like other hospitals, treat the patient first, without regard to their insurance status or ability to pay.
To add insult to injury, her in-network hospital was just three blocks away. If she arrived there, the costs would add to $1500. Instead, the bills came rolling in, totalling $300K. Blue Cross did agree to pay what they would have paid the in-network hospital, which was $150,000.
St. Mary’s stepped up to the plate and covered 90 percent of the hospitals expenses, taking the bill down to $40,000 paid to the doctors involved in her care. That has her at the edge of bankruptcy, due to her lack of choice in the matter.
With the Affordable Care Act the law of the land, people are finding out that choice has been sacrificed in what was supposed to be lower prices. For every person that saves money under the plan, another gets socked with costs.
I’ll use myself as an example. When my plan was switched because it didn’t ‘comply’ with the ACA standards, my level of coverage actually dropped with the new plan. The whole if you like your plan, you can keep it didn’t apply to me. Expenses that were normally covered all of a sudden jumped higher. Copays went up, along with prescription drug cost.
For Megan Rothbauer, it is the frustration of having no choice. She’s lucky that the hospital and insurer are working with her, but in the end, it exposes a dangerous flaw that remains in our health insurance industry. Choice is being constrained.
You can blame the ACA, profit chasing by companies or whatever. Regardless, the idea behind the ACA was to prevent exactly what happened above. If you are covered under a good health insurance policy, this should never happen. If that means the ACA needs an overhaul, then so be it.
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