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The $109,000 Heart Attack Bill Is Down To $332. What About Other Surprise Bills?

| September 4, 2018

Drew Calver sits with his wife, Erin, and daughters Eleanor (left) and Emory (middle) in their Austin, Texas, home where he had a heart attack on April 2, 2017. Calver, a high school teacher, has health insurance through his school district, but still faced a $108,951.31 bill. (Callie Richmond for KHN)

Drew Calver sits with his wife, Erin, and daughters Eleanor (left) and Emory (middle) in their Austin, Texas, home where he had a heart attack on April 2, 2017. Calver, a high school teacher, has health insurance through his school district, but still faced a $108,951.31 bill. (Callie Richmond for KHN)

A Texas hospital that charged a teacher $108,951 for care after a heart attack slashed the bill to $332.29 Thursday — but not before the huge charge sparked a national conversation over what should be done to combat surprise medical bills that afflict a growing number of Americans.

The story of Drew Calver was first reported by Kaiser Health News and NPR last week as part of the a series that examines U.S. health care prices and the troubles patients run up against in the $3.5 trillion industry.

In Calver’s case, the 44-year-old father of two had suffered a heart attack in April 2017 and a neighbor rushed him to the nearest emergency room, which was an out-of-network hospital under his school district health plan. His insurance paid the hospital nearly $56,000 for his four-day hospitalization and procedures to clear his blocked “widow-maker” artery.

But the hospital, St. David’s Medical Center in Austin, wasn’t satisfied with that amount and went after the high school history teacher and swim coach for an additional $109,000 in a practice known as “balance billing.”

Within hours of the story publishing, the hospital offered to waive nearly the entire bill and charge him $782.29 instead. By Thursday, St. David’s lowered the amount even further. Calver said he paid it off over the phone, eager to put this stressful saga behind him.

Calver said it’s a relief that his family doesn’t face a six-figure bill and threatening letters from the hospital’s debt collector. But he said he worries about other patients hit with unjust medical bills of $10,000 or $20,000 who don’t catch the media’s attention.

“It feels great that this is over for me and my family. But this isn’t just about my bill,” Calver said in an interview. “I don’t feel any consumer should have to go through this.”

Calver and his wife, Erin, said they were encouraged by the outpouring of support and attention they received. Drew Calver gave local TV interviews after teaching class and his story was featured on CBS This Morning. The couple said they’re hopeful the national conversation that ensued will lead to changes that help other consumers across the country.

Just after paying off his hospital bill, Calver walked to the school cafeteria Thursday to grab lunch. One of the cafeteria workers approached him and shared that she, too, was facing a huge medical bill from the same Austin hospital. Calver said he plans to follow up with the woman and assist in any way he can.

“This is the next way I can be of help to others,” he said.

The hospital system, St. David’s HealthCare, continues to defend its handling of Calver’s bill, saying it “did everything right in this particular situation.” It also pointed out that it informed the family on several occasions that they could apply for a discount through a financial assistance program, based on their household income.

Calver said he didn’t fill out the financial assistance paperwork earlier because he didn’t feel he owed the $108,951 — and had been contesting the validity of the charges all along.

His health plan said the $55,840 it paid the hospital should have satisfied the hospital’s claim. And Calver was already paying $1,400 as coinsurance, which was the out-of-pocket amount calculated by his health plan.

HCA Healthcare, the largest for-profit hospital chain in the country, and two nonprofit foundations own St. David’s.

The chief executive of St. David’s HealthCare, C. David Huffstutler, wrote a memo Monday addressed to his board of governors about Calver’s story. A St. David’s employee shared the memo with Kaiser Health News, and the hospital didn’t dispute its accuracy.

“I realize this is not the type of coverage any of us want for St. David’s HealthCare,” Huffstutler wrote in his Aug. 27 memo. “With this story, we had a number of circumstances that made it difficult to neutralize the coverage — a monthly news segment that seeks to empower patients to challenge their medical bills; a gap in the system that is affecting patients … and, a compelling patient story.”

Huffstutler also wrote that the hospital’s charges of $165,000 were “reasonable and customary.” He said that the school district and its health plan administrator, Aetna, chose to offer a narrow network plan that “can potentially place a heavy financial burden on the patient.”

Consumer advocates said the hospital should have erased the bill completely after putting the family through so much stress for months.

The drastic reduction in the bill “shows that these hospital numbers are just made up,” said Bonnie Sheeren, who runs Houston Health Advocacy and assists consumers with their medical bills. “It should be a zero balance, and the hospital should pay for therapy sessions to help this family recover from the billing ordeal.”

Several states have passed laws or introduced programs to help shield patients from surprise medical bills, particularly those stemming from emergencies.

But those state rules don’t apply to most U.S. workers because they get their health coverage from employers that are self-insured, meaning the companies pay claims out of their own funds. Federal law governs most of those health plans, and it does not include such protections.

Rep. Lloyd Doggett (D-Texas) heard Calver’s story on the radio while driving Monday and immediately wrote the family a letter offering his support. Calver teaches at the high school that Doggett attended.

The lawmaker proposed legislation last year aimed at limiting surprise billing for patients, but he said it hasn’t received a hearing in the current Congress.

“This is a nationwide problem, and we need a nationwide solution,” Doggett said in an interview. “We have a system where the patient, the most vulnerable person of all those involved, is caught between the insurer and the health care provider. … These problems are solvable.”

Zack Cooper, an associate professor of public health and economics at Yale University, has studied hospital billing practices extensively and said the nearly $109,000 bill was no accident.

He noted that St. David’s, like other hospitals, advertises short wait times for its emergency rooms in order to attract out-of-network patients like Calver. Cooper said his case illustrates the need for better regulation of out-of-network billing at the state or federal level.

“The idea that a hospital would send a bill that will probably bankrupt an individual boggles the mind. For me, that is emblematic of a fairly toxic culture,” Cooper said.

“This was a remarkable story, and it has done remarkable good for him,” Cooper added. “But we shouldn’t be in a world where to avoid financial ruin you have to hope your story is featured in the popular press. We can do better than this.”

–Chad Terhune, Kaiser Health News

Ashley Lopez of member station KUT in Austin contributed audio reporting. “CBS This Morning” featured it last Wednesday. Do you have a bill you would like us to examine? Submit it here.

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14 Responses for “The $109,000 Heart Attack Bill Is Down To $332. What About Other Surprise Bills?”

  1. capt says:

    This really shows the greed that exist in Hospitals throughout the United States and how crooked and under handed the heath insurance companies are. . Placing a family on the brink of financial ruin doesn’t really bother these “health institutions. Its all a number and profit game to them.

  2. Richard says:

    If I were presented with a similar bill from a hospital who were attempting to gouge me for services already paid by my insurance company I will tell them that they will be receiving a letter shortly from my bankruptcy attorney. End of discussion.

  3. MannyHM says:

    More important than the bill correctly reduced is to rectify the system that put them there in the first place.

  4. Sherry says:

    Couldn’t agree more capt.

    Universal health care, regulated at the “Federal” level. . . something similar to Medicare For All. . . could certainly go a long way towards stopping this kind of “Highway Robbery”.

    But, then again, those freaked out over “anything” for the “common good” is stopping that from happening.

  5. Mark says:


  6. Michael Cocchiola says:

    Mark…I just don’t get people like you. What does this issue have to do with the Affordable Care Act? And your insulting and juvenile characterization of a federal program that provides health care to millions of Americans who, before the ACA had nothing, is spectacularly uninformed. I would guess you’re a trumper, so I guess explains about everything.

  7. palmcoaster says:

    Mark is not “your insulting OBUMACARE” the reason for the gouging but instead one of those HCA’s like The Columbia HCA remember..? were Rick Scott was the Chair and escaped with a slap on the wrist for stealing billions from Medicare too?

  8. Nancy N. says:

    Richard, your suggestion of bankruptcy as a solution is offered quite flippantly and seemingly without understanding of how devastating bankruptcy is on both people’s personal financial lives and the medical system in general.

    A large portion of bankruptcies (like my own a few years back) are at least partially about medical bills. You might think that you can just wave a wand and make the bill go away with a bankruptcy. But the bankruptcy court will take everything you own first to satisfy your creditors. So you better hope you don’t have a house with equity, a car, a boat, or an IRA retirement account. Or a business. Or any other asset, large or small, that you don’t want to part with.

    You’ll spend years unable to get credit. Ever tried to exist in the modern world without a credit card? It’s not easy. You’ll probably pay penalties in your car insurance rates. And heaven help you if you need to rent a place to live.

    But sure, wave that magic bankruptcy wand and make that big medical bill go away. Did you know that you can only file bankruptcy every 8 years? What happens when another massive medical bill comes your family’s way in 2, 3, or 4 years from now?

    And that isn’t even considering what having to write off all these unpaid bills does to hospitals and other medical institutions, and to medical billing rates for other patients. It’s a vicious cycle….

    This is just part of the reason why we need Medicare for All single payer.

  9. Richard says:

    Sure sounds like you got the wrong bankruptcy lawyer after reading just a few Internet searches on whether you can keep your house and IRA when filing bankruptcy, I am not advocating for anyone to file bankruptcy when presented with a ridiculously expensive medical bill, however I would bet my mortgage on the possibility that it would be reduced or even eliminated once they are presented with a bankruptcy notice. Medical bills are not high on the list of creditors who will get paid FIRST.

  10. Bernie 2020 says:

    How does a bill go from $109,000 to $332? That alone should be the thing we are discussing. Why is it when I do ask my insurance company BEFORE I go to the doctor they can’t tell me what my costs will be but when I build a house or fix my car they can? Medicare for all is the option. We don’t need insurance companies making our medical decisions, that is why we have doctors.

  11. Katie Semore says:

    Yup, the usual comments from the no-it-alls who in reality know nothing except what trump tells them. As if anything he has to say has any merit or is even believable. Don’t tell me who you are because who you really are is speaking so loudly I can’t hear you.

  12. Stanley Hardy says:

    Katie when excoriating approximately half the country it would be helpful if you used the correct idiom, i.e. “know-it-all,” v. no-it-all.” Thank you.

  13. Mary Fusco says:

    Bernie, sadly Medicare pays nothing in full. You will need supplemental insurance which can be quite expensive. Sadly, hospitals are charging outrageous amounts in part to make up for the deadbeats that come through the ER with no insurance and no way to pay. Who takes their child to an ER for an ear infection? Easy, someone who does not want to pay. People have milked the system for years. My daughter is an RN and does home health care right now. She sees it daily. Patients are sent home before they are ready and alot of those receiving home care DO NOT need it. It’s a vicious cycle.

  14. Katie Semore says:

    @Stanley, it was deliberate and my attempt at poetic licensing and sarcasm.

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