Having health insurance remains no guarantee patients will avoid massive ER bills in Utah
MURRAY, UT —
(KUTV) Getting hurt is never a fun thing, but it can be especially devastating here in Utah. Having an emergency sometimes leaves people forced to choose between losing their lives or losing their shirts in the Beehive State.
The problem arises when a patient goes to -- or is taken to -- the wrong hospital in an emergency; is the hospital in-network with the patient’s insurance or is it out-of-network?
Patients who are rushed to an out-of-network ER may find themselves hit with massive bills for any amount above what his or her insurance company won’t pay.
Last summer, a brutal dirt bike accident left Dane Allred clinging to life. He had 15 broken bones and a collapsed lung.
“One of the guys [in the ambulance] put his stethoscope up to my chest and he didn't say anything. He just looked at his colleague and said, 'we need to get him on a helicopter right now,’" Allred said.
The next thing Allred knew, he was in the air, doped up on painkillers.
"There was no, ‘What insurance do you have?’ ‘Where would you like to go?’” Allred said. “I was in so much pain I just let them do their thing."
He was flown to the Intermountain Medical Center in Murray where doctors saved his life. He's glad to be recovering from the medical stuff but now needs help recovering from the bill.
"We are now facing $38,000 in medical bills that we were blind-sided by," Allred said.
IMC is not in-network with Allred's health insurance, Regence Blue Cross Blue Shield. So, of the $45,878.69 bill, Regence paid a mere $7,949.72. That’s the amount Regence claims they would have paid had Allred been taken to an in-network ER. IMC passed the balance of the bill on to Allred telling him to pay $37,811.68.
"That's college fund for our kids. That is a rainy day fund. That takes up all of the money for anything extra we have in life,” Allred said.
Neither Regence nor IMC would talk to Get Gephardt on camera for this story but, in statements, they point their fingers at one another.
IMC says Regence paid less than half of what it should have paid.
Regence says IMC should write-off the bill's balance which is what the hospital would do if Regence were in-network with IMC.
Stories of medical insurance nightmares like Allred's have the attention of some Utah lawmakers. Rep. Jim Dunnigan even invited Allred's wife, Kalee, who has been dealing with the bills, to testify before a house committee last month.
"Thirty eight thousand dollars is so much money,” she told lawmakers with emotion in her voice. “We took all of the proper precautions to make sure we didn't get put in a situation like this. We had insurance."
Dunnigan ran a bill that would have outlawed the practice of sending the balance of medical bills on to patients in emergency situations after hearing dozens of horror stories from patients. The bill would also have set rates for procedures so insurance companies couldn't arbitrarily decided an unfairly low amount to pay.
A law change is critical, especially for critical patients, Dunnigan argued.
"[Emergency patients] don't have a choice in where they're going to go. They're unconscious. They're severely hurt," Dunnigan said.
His bill passed the house but died in the senate. Dunnigan said it faced too much push back from hospitals and doctors.
Dunnigan said he will work over the summer and try to run a bill again, possibly in 2018.
As for Dane and Kalee, an IMC spokesperson told Get Gephardt Monday that the couple should try and convince Regence to pay more.
“Regence has … paid an arbitrary amount with the hopes that the hospital would accept this as payment in full. The hospital subsequently billed the patient in hopes that he can get his insurance company to come forward with an appropriate amount. Were the hospital to simply accept as payment-in-full whatever amount an insurer arbitrarily decided to send, we could not keep the lights on and serve the community in the way that we do,” IMC wrote.
The argument echoes what several doctors and medical group argued at the legislature trying to stop Dunnigan’s bill from advancing.