American woman received a bill from the hospital for $ 227 thousand, despite the availability of insurance

The first unpleasant surprise in the life of Debbie Mönckke was an extensive heart attack, which occurred when a woman waited for her turn to see a doctor in the summer of 2018, at a medical clinic in Vancouver, Wash. Time.

Фото: Depositphotos

“She had an appointment with the doctor because her feet were so swollen. But when she walked in, she started choking and kept saying that she couldn’t breathe,” said the woman’s husband, Larry Moenke.

Her life was suddenly threatened, an 59-year-old woman was rushed to the ambulance first to the local hospital where her condition was stabilized, and then the next day to the Oregon Health and Science University (OHSU) in Portland to provide emergency cardiac care.

She underwent an operation on the heart, during which one valve was replaced and the other was restored. As soon as Debbie Möncke recovered from all this, she developed an aggressive infection, which required powerful antibiotics to be treated. She spent a month in a hospital, part of which was in the intensive care unit, before she was allowed to go home.

And then she received the following surprise: bills totaling more than 454 000 dollars for a medical miracle that saved her life. According to officials, out of this staggering amount, she had to pay almost 227 000 dollars after her medical insurance paid out her share.

“If I had known, I would have refused life-sustaining procedures. We're going to lose everything,” said Debbie, a former waitress who suffers from early-onset dementia.

Large “unexpected medical bills” have become a national epidemic, and no US region has yet been able to find a solution to this problem.

The central problem is money. These surprise bills, or "balance bills," typically arise when a patient's insurer and an out-of-network hospital or physician cannot reach an agreement on the cost of services provided. In Moenke's case, the insurer, LifeWise Health Plan of Washington, paid what it considered fair. Providers then bill patients for the amount the insurer refused to cover, which can be tens or even hundreds of thousands of dollars.

According to the Commonwealth Fund, as of December 2018, 25 states had laws in place that protect patients from balance sheet accounts. These laws deduce consumers from disputes over the cost of services and oblige suppliers and insurers to negotiate until they reach an agreement on the amount.

If they cannot agree, then in many states arbitration is provided for this. In Washington state, such a bill is still under consideration.

While patients can usually avoid balance sheet billing by receiving services in the medical institutions of their insurance network, an emergency on the verge of life and death, similar to what happened to Debbie Möncke, can make the choice of treatment site impossible. In addition, many hospitals in a particular insurance network often use doctors who are not part of this network, which increases the risk of patients receiving unexpectedly large bills.

Even in those states where laws exist to protect patients, there are many loopholes in them. For example, hospitals are not prohibited from sending balance sheets to a patient; but the person who received it must know that it is protected by law and make considerable efforts to eventually challenge the bill.

In addition, about 60% of health insurance plans that employers pay are governed by federal law, not state law. Currently, there is no federal ban on issuing balance accounts, although last year a bill was passed to Congress to end this practice.

In the state of Oregon, where Debbie Moncke was treated, there is a law prohibiting balance sheet accounts, it came into force in the 2018 year. But this only applies to payments sent to a patient who has received help from a provider within the network, and applies only to insurers whose work is managed by the state, and Möncke’s insurance plan is not.

70-year-old Larry Mönke, a truck driver, noted that the couple did not have the money to pay a huge bill.

Larry and Debbie are married 32 of the year, and live with their two dogs, Coco and Bell, in an 47-year-old mobile home in southwest Washington. Larry Möncke can no longer work, because after a heart attack of his wife he had health problems. They receive social security income in the amount of 1 884 dollars per month.

The representative of the insurance company LifeWise, which includes the insurer Mönke, Bo Yungmeier, said that the insurer had paid for its emergency medical care in the amount required in accordance with the Law on Affordable Health Care.

Debbie Möncke was treated at the OHSU from August 14 to September 12 on 2018. She was initially hospitalized for emergency treatment of the heart. There, she became ill with an unidentified infection, which required two more weeks of treatment.

Only later did the couple find out that they could have transferred her for treatment of the infection to a hospital operating in the insurance network, which would potentially save tens of thousands of dollars.

“They never said anything about them being out of the insurance network or anything like that,” Larry Moenke said.

Debra Thomsen, OHSU's billing director, said that LifeWise officials had to notify Möncke after receiving bills worth about 250 000 dollars in the middle of her stay in treatment.

“The insurer has to tell the patient that they will incur costs,” she said.

LifeWise's Jungmeier said OHSU should have been the one to tell Debbie Moenke about the high bills — and the possibility of transferring to another hospital.

“We typically allow this type of conversation between the provider and the patient while the patient is there. I don’t know why OHSU didn’t ask them about this,” said an insurance company representative.

In early March 2019, after repeated requests for Debbie Moenke's treatment—first from reporters, then from a patient advocate provided by the Washington State Insurance Commission—the couple's accounts were eventually withdrawn.

With the help of Jared Walker, who runs a non-profit organization Dollar for portland, the couple applied for cancellation of medical debt as a charity, which is quite a difficult process. OHSU officials approved the application and wrote off the pair’s debts.

Read also on ForumDaily:

Study: eggs for breakfast increase the risk of disease and early death

What to do if you got a medical surprise bill

How to save when you live in America

Do you want more important and interesting news about life in the USA and immigration to America? — support us donate! Also subscribe to our page Facebook. Select the “Priority in display” option and read us first. Also, don't forget to subscribe to our РєР ° РЅР ° Р »РІ Telegram  and Instagram- there is a lot of interesting things there. And join thousands of readers ForumDaily New York — there you will find a lot of interesting and positive information about life in the metropolis.