If 29 year old Megan Rothbauer had been taken three more blocks to Madison, WI's, Meriter Hospital when she had a freak heart attack, she'd have owed $1500, but since the comatose woman was brought to St Mary's Hospital, which Blue Cross Blue Shield won't deal with, she owes $50K and is facing bankruptcy.
In Rothbauer's case, her insurer, Blue Cross Blue Shield, said it paid St. Mary's 100 percent of its in-network rate or $156,000 to cover part of the original $254,000 bill that she incurred during 10 days in a medically-induced coma and another six days in the cardiac unit. St. Mary's negotiated with Rothbauer to reduce the remainder of her $98,000 bill by 90 percent. This is separate from the bills she received from the doctors, the ambulance, the therapist and others.
Gaines said consumers have little chance to negotiate against the parties in the health care industry as they don't have the necessary tools.
"I mean, I know this business. I've been doing this for a while, knocking on doors, trying to understand this data and I have no ability to do it. None," Gaines said. "When they don't even disclose the cost (of services), there's the cost. There's the price. There's the charge. There's the accepted payment. Lions, tigers and bears, oh my. How do you even know what's what in this world?"
"It is totally random, and it is the problem with saying consumers have to go to the right hospital and you say, 'What if you're unconscious?'" Gaines said.
Woman taken to 'wrong' hospital faces bankruptcy [Adam Schrager/Channel 3000]