A Wisconsin woman went into cardiac arrested in September 2013 and was taken to the hospital while unconscious. More than a year later, she's battling a medical bill that is tens of thousands of dollars more than what she would have paid if paramedics had taken her to another hospital just blocks away.
When Megan Rothbauer was rushed to the emergency room last year, if first responders had taken her to Meriter Hospital instead of St. Mary's Hospital, which are within three blocks of each other, it would have meant the difference between a $1,500 bill and the more than $50,000 she now faces from the out-of-network hospital.
"I was unconscious when I was taken to the hospital," Rothbauer told WISC-TV. "Unfortunately, I was taken to the wrong hospital for my insurance.
Megan Rothbauer says she and her future fiance are consider second jobs or even filing for bankruptcy if they can't get the bills reduced further. (Image source: WISC-TV)
"I was in a coma. I couldn't very well wake up and say, 'Hey, take me to the next hospital.' 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 said.
According to WISC, this is a "billing balance" issue.
"While the local insurance companies that represent roughly 80 percent of those who have insurance in our area will offer out-of-network patients in-network rates during emergency room visits, there remains no guarantee they won't face hefty bills on the back end depending on the treatment they receive," the news station stated.
Scott Larrivee, public relations director for Anthem Blue Cross Blue Shield, Rothbauer's insurer, told WISC it has "little influence over what the hospital is charging in this situation."
The news station reported that Rothbauer's 10-day medically induced coma and six-day stay afterward cost $254,000, of which her insurance covered $156,000. Though the remainder was reduced by the hospital, that cost and other bills from services like the ambulance and therapy stacked up to around $52,000, according WISC.
Rothbauer said if she was taken to a different hospital her bill would have been $1,500. (Image source: WISC-TV)
"I can only do so much. The hospital can only do so much. And I think the best outcome is the person walked away from the emergency room," Cyn Gunnelson, who works for SSM Health Care systemCare, which is the system St. Mary's Hospital is part of, told the news station.
Going forward, Rothbauer said she is trying to negotiate with her insurer, but if the cost cannot be reduced further she and her boyfriend — they are delaying getting engaged because of financial stress — are considering second jobs, taking money from retirement accounts or even filing bankruptcy, WISC reported.
"It's devastating for people who plan, who get insurance, get coverage, do everything they can and then, at 29, have a heart attack and get taken to the wrong hospital, and can't get married, can't do anything because they have to declare bankruptcy because they can't afford to have gone to the hospital," Meg Gaines with a health care advocacy group out of the University of Wisconsin-Madison Law School told WISC. "I mean, it's not enough to worry about having a heart attack at 29, you end up with a secondary one or a stroke because of your medical bills. I mean, it's just ridiculous. The level of frustration is astronomical."
This story has been updated to correct a typo.