美国国家公共电台 NPR Life-Threatening Heart Attack Leaves Teacher With $108,951 Bill

 

DAVID GREENE, HOST:

Every month, NPR and Kaiser Health News take a close look at medical bills that you send us. And this week, you're going to be hearing the word surprise a lot. And that is never a word you actually want to hear in the same sentence as medical bill, especially if you are just coming back from emergency heart surgery and the bill is for a six-figure amount that you apparently¹ owe. Elisabeth Rosenthal is the editor-in-chief of Kaiser Health News, and she is back in our studios. Hi, Elisabeth.

ELISABETH ROSENTHAL: Hi, great to be here.

GREENE: This is making me nervous just thinking about it. You have heart troubles. You go for emergency surgery. And now when you're just recovering, you're told that you owe a ton of money.

ROSENTHAL: Yeah, it's scary. Our August bill of the month is for a Texas man's medical costs after the insurance company has already reimbursed² the hospital - crazy. His name is Drew Calver. He's a high school teacher and swim coach in Austin, Texas. And we'll hear Drew tell his story in a moment, but what he faced that day was a really common financial issue. When the hospital and insurer can't agree on a price, the patient is left holding the bag.

GREENE: And stressed out at a moment when he's recovering from a heart attack. I mean, that sounds unfair.

ROSENTHAL: Right, this insurer had already paid out $55,000, which from what we can tell is a very reasonable, generous price to pay for his procedure. But the hospital thought that his care was worth much, much more. And so they tried to bill about $150,000 and billed him for the difference. So that's called balance billing, the balance after insurance paid. We're talking about an amount that's double his teacher's salary. For him, it was an unexpected bill that, as far as he understood, was not covered under the terms of his insurance. So it was what we call surprise billing.

GREENE: OK. So these terms, just so I understand it, balance billing - when the hospital tries to make up for what they think they are owed. Once that balance billing ends up in Drew's mailbox, that's called surprise billing.

ROSENTHAL: Balance billing is one form of surprise billing.

GREENE: All right, well, let's actually meet Drew Calver. Ashley Lopez from member station KUT in Austin went to pay him a visit. And he took her back to the day of his heart attack.

ASHLEY LOPEZ, BYLINE³: A little more than a year ago, Drew was taking out the trash on a Sunday morning. His wife, Erin, was heading to the store with one of their daughters. He remembers waving at them.

DREW CALVER: And then as I turned the corner from the driveway, I just had that back pain.

LOPEZ: Drew says he started to keel over. He then stumbled⁴ back inside the house where he saw Eleanor, his older daughter.

D. CALVER: And I literally⁵ said to her, Eleanor, I think I'm dying.

LOPEZ: Through waves of pain, Drew managed to reach his wife who then got a neighbor to drive him to a hospital that's less than a mile away. Turns out, Drew was having a particularly dangerous kind of heart attack known as the widow-maker. And this was a huge surprise because just a few months before, Drew was in a half-Ironman.

D. CALVER: I mean, I was a swimmer in college - high school and college, so always been in pretty good shape.

LOPEZ: Once Drew was stabilized⁶ at the hospital, doctors planned to put stents in to open up his blocked arteries⁷. Before the actual procedure, he made sure to ask whether his insurance would cover all of that.

D. CALVER: And they said, yeah, with - your insurance is - accept it. You know, we've called them, and they've given us the OK.

LOPEZ: All together, Drew was in the hospital for four days.

ERIN CALVER: Those are from the ninja place.

(CROSSTALK)

LOPEZ: Life is pretty much back to normal these days, he says. Drew's wife, Erin, and his two daughters, Eleanor and Emory, ages 7 and 6, are getting ready to walk to school. He says surviving a heart attack has made him appreciate this time with his family even more. But there is one big thing that is still hanging over them. That's those hospital bills that came flooding in right after his heart attack.

D. CALVER: I've got some different sets in some of these.

LOPEZ: According to the hospital, Drew owes almost $109,000.

D. CALVER: It just kind of got real all of the sudden. They're like no. Hey, your insurance isn't going to pay this. You owe this.

LOPEZ: This medical debt is raising a lot of questions.

(CROSSTALK)

LOPEZ: While walking their daughters to school, Drew and Erin say they don't know how to plan their finances⁸.

E. CALVER: Will we be able to get a car loan? Will they come after our 401(k)? You know, just all this stuff, and just thinking, like, this cannot be right.

LOPEZ: And for Drew, this massive⁹ hospital bill isn't making it any easier to recover from his heart attack.

D. CALVER: For me, I'm trying to reduce that stress in my life. That's part of my doctor's recommendations¹⁰, you know, my doctor's orders.

LOPEZ: And Erin says they've been dealing¹¹ with the worry of all this for a year now.

E. CALVER: I just think that the bill in itself is so reprehensible¹².

LOPEZ: In the meantime, they say there's just no way they can pay that bill.

GREENE: All right. The reporting there you just heard was from Ashley Lopez at NPR member station KUT in Austin. I am still with Elisabeth Rosenthal, the editor-in-chief of Kaiser Health News. Elisabeth, what can Drew Calver do here?

ROSENTHAL: Well, the first thing everyone should know is try to go to an in-network hospital. However, if you're having a heart attack...

GREENE: Yeah.

ROSENTHAL: ...You're not Googling, you know, who's in network?

GREENE: No.

ROSENTHAL: You just go to the nearest place. So that's step one. The second step is don't just write the check. When you get a bill - a surprise bill or a balance bill that seems outrageous¹³, fight back with this because in many states now, including Texas, there are laws that protect patients from surprise bills. And basically what those laws say is if the provider - in this case, the hospital - and the insurer can't agree on a price, then the patient cannot be held responsible. He is held harmless, and the two of them will have to work it out among themselves.

GREENE: So this is good news for Drew.

ROSENTHAL: Well, except there's a big loophole in those laws. And that is that about 60 percent of plans are what we call self-insured, meaning you may have a network like Cigna or Aetna, but they are really just administering¹⁴ the plan. And the problem is those state laws don't apply to those self-insured plans. So even though Texas has a great law, it did not cover Drew's situation and hold him harmless.

GREENE: OK. So, Drew Calver, the lesson is don't pay yet. Try and fight it, but it's not clear that you will win. You might be stuck paying this money somehow.

ROSENTHAL: Well, maybe, but one thing that I advise people to do is if your state has that law, download the forms. Send them to the hospital. Send them to your insurer. And say, hey, look, this is a weird¹⁵ loophole. You know this is the right thing to do, and it does work sometimes. I've used that, and it worked in New York for me.

GREENE: Elisabeth Rosenthal is the editor-in-chief of Kaiser Health News. Thanks as always for bringing these stories to us. They're really good lessons.

ROSENTHAL: Thanks for having me.

GREENE: Hey, if you have an interesting medical bill, we would love to take a look at it. You can go to NPR's Shots blog to share your bill with us and with Kaiser Health News.

(SOUNDBITE OF SYNTH4EVER'S "FLOATING THROUGH THE PLANES OF EXISTENCE")

1 apparently   

adv.显然地；表面上，似乎

参考例句：

• An apparently blind alley leads suddenly into an open space.山穷水尽，豁然开朗。
• He was apparently much surprised at the news.他对那个消息显然感到十分惊异。

2 reimbursed   

v.偿还，付还( reimburse的过去式和过去分词 )

参考例句：

• Any out-of-pocket expenses incurred on the firm's business will be reimbursed. 由公司业务产生的开销都可以报销。 来自《简明英汉词典》
• Employees are reimbursed for any legal fees incurred when they relocate. 员工调往异地工作时，他们可以报销由此产生的所有法律服务费用。 来自《简明英汉词典》

3 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

4 stumbled   

v.（不顺畅地）说( stumble的过去式和过去分词 )；跌跌撞撞地走；绊脚；（说话、演奏等）出错

参考例句：

• I stumbled and sprained my ankle. 我摔了一跤，把脚脖子扭了。
• The child stumbled and fell. 孩子绊了一下，摔倒了。

5 literally   

adv.照字面意义，逐字地；确实

参考例句：

• He translated the passage literally.他逐字逐句地翻译这段文字。
• Sometimes she would not sit down till she was literally faint.有时候，她不走到真正要昏厥了，决不肯坐下来。

6 stabilized   

v.（使）稳定， （使）稳固( stabilize的过去式和过去分词 )

参考例句：

• The patient's condition stabilized. 患者的病情稳定下来。
• His blood pressure has stabilized. 他的血压已经稳定下来了。 来自《现代英汉综合大词典》

7 arteries   

n.动脉( artery的名词复数 )；干线，要道

参考例句：

• Even grafting new blood vessels in place of the diseased coronary arteries has been tried. 甚至移植新血管代替不健康的冠状动脉的方法都已经试过。 来自《简明英汉词典》
• This is the place where the three main arteries of West London traffic met. 这就是伦敦西部三条主要交通干线的交汇处。 来自《简明英汉词典》

8 finances   

n.(pl.)财源，资产

参考例句：

• I need a professional to sort out my finances. 我需要专业人士为我管理财务。
• The company's finances are looking a bIt'shaky. 这个公司的财政情况看来有点不稳定。

9 massive   

adj.巨大的，大规模的，大量的，大范围的

参考例句：

• A massive sea search has failed to find any survivors.经过大规模的海上搜救仍未找到幸存者。
• He drank a massive amount of alcohol.他喝了大量的烈酒。

10 recommendations   

n.推荐( recommendation的名词复数 )；推荐信；正式建议；提议

参考例句：

• The board completely disregarded my recommendations. 董事会完全无视我的建议。
• Recommendations from two previous clients helped to establish her credibility. 两位以前的客户的推荐有助于确立她的诚信度。 来自《简明英汉词典》

11 dealing   

n.经商方法，待人态度

参考例句：

• This store has an excellent reputation for fair dealing.该商店因买卖公道而享有极高的声誉。
• His fair dealing earned our confidence.他的诚实的行为获得我们的信任。

12 reprehensible   

adj.该受责备的

参考例句：

• Lying is not seen as being morally reprehensible in any strong way.人们并不把撒谎当作一件应该大加谴责的事儿。
• It was reprehensible of him to be so disloyal.他如此不忠，应受谴责。

13 outrageous   

adj.无理的，令人不能容忍的

参考例句：

• Her outrageous behaviour at the party offended everyone.她在聚会上的无礼行为触怒了每一个人。
• Charges for local telephone calls are particularly outrageous.本地电话资费贵得出奇。

14 administering   

管理( administer的现在分词 )； 治理（国家）； 给予； 执行

参考例句：

• Paramedics are to have extra training in administering on-the-spot treatment. 急救员要接受现场护理的额外培训。
• Hold the infant in cradle position when administering nose drops. 在滴鼻时要将婴儿抱成摇篮卧位。

15 weird   

adj.古怪的，离奇的；怪诞的，神秘而可怕的

参考例句：

• From his weird behaviour,he seems a bit of an oddity.从他不寻常的行为看来，他好像有点怪。
• His weird clothes really gas me.他的怪衣裳简直笑死人。