Teacher Facing $108,951 Hospital Bill After Suffering Heart Attack
AUSTIN, TX – August 30, 2018.
Drew Calver, 44, an Austin teacher, swim coach and a parent to two children, went to the nearest hospital after he had a heart attack. Doctors did an urgent operation for him and kept him in the ward for 4 days.
After Calver received the bill for treatment, he nearly had a second attack. The St. David's Medical Center billed him $164,941for his four-day stay in the hospital, plus heart surgery – which was roughly about double his annual salary.
He receives health insurance through the Austin Independent School District administered by Aetna and his health plan only covers $55,840 of that total amount.
Calver's story was first reported by Kaiser Health News with NPR. The numbers and documents about his billing and medical care were verified by Kaiser Health News.
He remembers being in the hospital and asking staff whether his insurance would cover the procedure.
"I'm on Seton, my Austin ISD [insurance] is Seton network, I just want to make sure I'm being covered by this," he recalled saying.
"And they said, 'Yeah we've accepted your insurance, your insurance has been contacted,' it sounded like they'd said yes," Calver said, noting at that point he'd checked insurance coverage off his mental list of things to worry about.
Calver's wife added that hospital staff told them his insurance would be covered regardless of the hospital because it was an emergency situation.
Then around a month later, he saw the bill.
Calver thought it was a mistake. He began spending his free time calling back and forth between St. David's and his insurance provider to see if there had been an error in how the bill was charged. He and his wife Erin described the process as "like having second, third and fourth jobs."
In May of 2018 was when Calver said debt collectors began calling him on behalf of St. David's, telling him he had to pay the amount in full.
St. David's HealthCare told KXAN Tuesday that when a patient comes to one of their hospitals, the top priority is to get the patient stable, and afterward staff will check insurance coverage. If St. David's finds their hospital is out of network for the patient's insurance plan, they try to transfer the patient somewhere that will take their insurance. But in emergency situations, they are not always able to do so.
Tuesday St. David's HealthCare told KXAN that they have a financial assistance policy for patients that offers discounts based on patient income. A spokesperson explained that if the Calvers apply for financial assistance, St. David's estimates the Calvers' bill would be reduced to $789.29.
Drew Calver said he'd absolutely be willing to apply and if that dollar amount is accurate, he'd be relieved to only have to pay several hundred dollars. But he said that is the first he's heard of that amount and is dismayed that no one with St. David's communicated that with him. He feels like St. David's is disregarding the more than a year his family spent in limbo thinking they'd be saddled with a six-figure bill.
St. David's healthcare maintained that it was the limitations of Calver's insurance plan which led to his large bill.
"While we did everything right in this particular situation, the structure of the patient’s insurance plan as a narrow network product placed a large portion of the financial responsibility directly on the patient because our hospital was not in-network with the patient’s insurance plan," a spokesperson for the health care system said in a statement.
St. David's also explained that debt collectors automatically started calling the Calvers, "due to the outstanding balance and because no financial assistance application had been completed by Mr. Calver and received by St. David’s HealthCare."
The spokesperson for St. David's also said that between July 2017 and April 2018, St. David's "was in frequent communication with Mr. Calver about his account."
But Calver said he struggled to get answers from St. Davids and Aetna about how much he owed or how he could get financial relief during that time. He said he was only told about the financial assistance program in August (though St. Davids said they sent him the paperwork in April 2018 as well).
There were also some questions about the costs for his care. For example, the four stents placed in his heart cost around $19,000 dollars each.
"I think it's important that people realize that even with insurance, it doesn't mean you're covered," said Erin Calvert. "Our system is flawed and it needs to be fixed, because this should not happen."
"I think that's why we want to tell our story, because it's not right," she added.
According to the Texas Medical Association, insurance companies save money by significantly limiting which doctors and hospitals they include in their networks. TMA is calling for more statewide transparency in this area and advocating for insurance plans to have more hospitals, doctors, and lab services in-network. Their association also pushed to get a bill passed in Texas to allow more patients to enter mediation if they have a disputed medical bill. That bill went into effect in January 2018.
TMA also has resources encouraging patients to protect themselves from surprise bills. A spokesperson for TMA suggested that people should check whether the doctors they're looking to go to are in-network because the patient will almost always wind up having to pay more for the bill if they go out of network.