Plan B Forum

A Wisconsin woman faces financial ruin after being rushed, while unconscious, to a hospital not covered by her medical insurance.

The plight of Megan Rothbauer, who spent 10 days in a medically induced coma following a heart attack in September last year, has highlighted the complexity of the American health insurance system.

American health insurers draw a distinction between hospitals “in network”, where they cover most of the cost of the treatment, and those outside the network where they pick up a far smaller slice of the bill.

Ms Rothbauer, 30, who suffered a heart attack at work in Madison, was rushed by ambulance to the nearest hospital, St Mary’s.

Unfortunately it was not part of the network approved by her insurer, Blue Cross-Blue Shield and it left her with a $52,531.92 (£33,373.53) bill for her care.

Had the ambulance continued for less than half a mile to Meriter Hospital, which is “in network”, the bill would have been a more modest $1,500 (£953).

‘”I was in a coma. I couldn't very well wake up and say, ‘Hey, take me to the next hospital'," she told WISC TV. 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,

“It was the closest hospital to where I had my event, so naturally the ambulance took me there. No fault to them."

The full bill for her treatment at St Mary’s was $254,000 ($161,000), but Blue Cross-Blue Shield agreed to pay $156,000 (£99,000).

This left an outstanding amount of $98,000 (£62,259) and the hospital wrote off 90 per cent of the bill, leaving Ms Rothbauer having to find $9,800 (£6,225) to settle St Mary’s account.

But she was still left with bills from the individual doctors, therapists and ambulance, which took the total back over $50,000.

Had she been taken to her approved hospital, Ms Rothbauer’s total out of pocket expenses would have been capped at $1,500.

“I had no control and I still have no control over what happens to my life,” she added.

MajGenl.Meade wrote:Lawyer up, lady! The policies I've had have always been clear that emergency non-network where there's been no conscious choice, were covered. In this case, I'd think she'd have a better than average chance of getting the insurer to recognize that she didn't choose to go out-of-network and was unable to rectify the problem due to being in a coma. There's a suggestion that the hospital should have known it and fixed it.