Despite health care plan, Utah woman gets slapped with a $140K bill after stroke
(KUTV) Larry Walker can't get the images out of his head. He came home from work and found his wife in bed. He couldn’t get her to respond.
He frantically called 911 and she was rushed to the Intermountain Medical Center in Murray, Utah by ambulance.
His wife, Judy Walker suffered a stroke. Doctors saved her life, not a simple feat.
"She had basically died twice during this whole stay in the hospital," Larry Walker said.
It has been a long road to recovery in the months since – a road that began with three weeks in the hospital. It was a lot of time that racked up a bill for a lot of money. Intermountain Medical Center sent a bill for nearly $200,000.
Judy Walker has medical coverage with Arkansas Blue Cross Blue Shield. It’s a self-funded plan through her employer. But of the $196,550.09 bill, BCBS will only cover $55,681.24. Walker and Judy Walker are being stuck with the rest: $140,868.85
"It's overwhelming, it's just totally overwhelming,” Larry Walker said. “I mean what am I supposed to do with [$140,000]? My wife is now on [Social Security Diability] payments because she cannot work."
The Intermountain Medical Center is not considered in-network with Arkansas Blue Cross Blue Shield. Federal law says that, in an emergency, all hospitals are supposed to be considered "in network," with hospitals billing the types of reasonable rates they might negotiate with an in-network insurance carrier. Likewise, insurance companies are supposed to pay such reasonable rates. The argument is that an unconscious or seriously wounded patient who needs care quickly shouldn’t be financially punished for going to the closest ER.
That said, examples frequently pop up about people who are insured, and end up with massive medical bills anyway because they ended up at an out of network hospital. Get Gephardt has reported many such stories. Utah law does not require hospitals write-off balances above what insurance is willing to pay, nor that insurance companies pay more then what they deem to be a reasonably contracted rate.
While Larry Walker said he's grateful for the care his wife received, he says he’s frustrated with communication he received from the hospital during her recovery.
"There wasn't one person that warned us that we were racking up a huge bill because we happened to be out of network, that our insurance was not covered with that hospital," he said.
In an email to Get Gephardt, the insurance company, Arkansas BCBS pointed the finger at the hospital, writing that Intermountain is "demanding nearly four times" what other Utah hospitals would accept as payment in full.
An Intermountain spokesperson snapped back that the hospital’s rates are "affordable" and that "any suggestions otherwise by Blue Cross Blue Shield of Arkansas is inaccurate and ill-informed."
Intermountain points the finger right back at BCBS claiming the hospital received “pre-authorization" to treat Judy Walker, but then the insurance company changed its tune, saying "she would not be fully covered" after all.
BCBS says $56,000 is all Judy Walker's plan allows them to pay.
All that finger pointing doesn't help the Walkers. What might is if the insurance company and the hospital can find a compromise. Intermountain says it's trying to convince the insurance company to pay more. The insurance company wants Intermountain to charge less.
Meanwhile, Larry Walker and Judy Walker now teeter on the edge of bankruptcy.
"I'm here alone trying to pick up the pieces like really? $140k? What am I supposed to do with that? What can I do with that?” Larry Walker said.