As reported by Kaiser Health News and NPR on Monday as part of the “Bill of the Month” series, the Calver case is all too familiar. The 44-year-old father of two had suffered his heart attack in April 2017 and rushed to the nearest emergency room. That happened to be an out-of-network hospital. Accordingly, his school district health paid roughly $56,000 for the four days of hospitalization and later procedures.
St. David’s Medical Center in Austin then hit Calver with an additional $109,000 in as a “balance billing.” That is when Calver went public and that amount was immediately reduced to $782 and then down to $332.
The case captures the “funny money” approach of this inherently dishonest process. Despite endless examples of inflated billing in this broken system, Congress continues to do nothing. It has left patients to be abused and threatened in a process where these bills are little more than hold ups — or calculated to make patients spend endless hours to challenge and correct. It is an utter disgrace.
It is clear that Calver’s media coverage not his insurance coverage was the reason for this change.
Despite this ridiculous record, St. David’s HealthCare, continues to say “did everything right in this particular situation.” So this absurd series of billings and a reduction of $109,000 to $332 is just right in the insane medical insurance system in the United States.