When Megan Rothbauer had a heart attack in September last year, the ambulance brought her to St. Mary's Hospital in Madison, Wisconsin.
Bringing Rothbauer, who was unconscious when the paramedics arrived, to St. Mary's emergency room appeared to be the best idea at the time. For one it is the nearest hospital to where the then 29-year old project manager for a Madison company had a cardiac arrest, but for Rothbauer, being rushed to St. Mary's and not to Meriter Hospital, which is just three blocks away, spelled a big difference.
Meriter Hospital is in Rothbauer's insurance network, but because she was sent to the out of network St. Mary's, Rothbauer is now facing $50,000 in bills instead of just spending $1,500 in out of pocket expenses had she been sent to Meriter Hospital. Rothbauer survived from her medical ordeal but is now facing bankruptcy.
"I was in a coma. I couldn't very well wake up and say, 'Hey, take me to the next hospital,'" Rothbauer said. "It was the closest hospital to where I had my event, so naturally the ambulance took me there. No fault to them. It's unfortunate that Meriter is in network and was only three blocks away from St. Mary's."
Rothbauer racked in $254,000 in hospital bills during the 10 days she was in a medically-induced coma and nearly a week in a cardiac unit recovering from the cardiac event that nearly killed her. Her insurer, Blue Cross Blue Shield, paid some of her hospital bills through a practice known as "balance billing," wherein the patient is billed for the difference between what the hospital charges and what the patient's insurance company covers.
Blue Cross Blue Shield paid the hospital 100 percent of its in-network rate, or $156,000 of the $254,000 that Rothbauer has incurred. Rothbauer negotiated with the hospital to reduce the remaining $98,000 hospital bill by 90 percent but while St. Mary's did reduce the bill; the reductions do not include the bills that cover the services that Rothbauer received from the ambulance, doctors and therapists.
Rothbauer and her boyfriend Ben Johnsen were planning to get engaged, but because of the unfortunate event that had her sent to a hospital that does not accept her insurance, this had to be postponed as Rothbauer looks for ways to pay off her medical bills. She could cash out her retirement accounts, get a loan, or file for bankruptcy.