Health Care

When Drew Calver had a heart attack last year, his health plan paid nearly $56,000 for the 44-year-old's emergency hospital stay at St. David's Medical Center in Austin, Texas, a hospital that wasn't in his insurance network. But the hospital charged Calver another $108,951. That sum — a so-called balance bill — was the difference between what the hospital and his insurer thought his care was worth.

Though in-network hospitals must accept previously contracted rates from health plans, out-of-network hospitals can try to bill as they like.

A Texas man has a heart attack – and good medical insurance – and still finds himself on the hook for $109,000 in medical bills.

Another man in Florida owed $3,400 for a CT scan, after his insurance company pays its part.

A Texas hospital that charged a teacher $108,951 for care after a 2017 heart attack told the patient Thursday it would slash the bill to $332.29 — but not before a story about 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 NPR and Kaiser Health News on Monday as part of the "Bill of the Month" series, which examines U.S. health care prices and the troubles patients run up against in the $3.5 trillion industry.

Editor's note: Shortly after this story by Kaiser Health News and NPR was published and broadcast on Monday, St. David's said it was now willing to accept $782.29 to resolve the $108,951 balance because Drew Calver qualifies for its "financial assistance discount." In a statement, the hospital said this offer was contingent on Calver submitting his application for a discount based on his household finances. Calver disputed that he owes any additional money to St. David's and said this situation should have been resolved long before now.

The patient at the clinic was in his 40s and had lost both his legs to Type 1 diabetes. He had mental health and substance abuse problems and was taking large amounts of opioids to manage pain.

He was assigned to Nichole Mitchell, who in 2014 was a newly minted nurse practitioner in her first week of a one-year postgraduate residency program at the Community Health Center clinic in Middletown, Conn.

The past two years have been a time of reckoning for pharmaceutical manufacturers over their role in promoting opioid drugs that have fed a national epidemic.

It's a club no one wants to join, but many Americans these days find themselves automatically eligible for the "Bill of the Month" club.

Kaiser Health News and NPR began collecting people's health care bills for examination early this year. We have waded through roughly 500 submissions, choosing just one each month to decode and dissect. (If you'd like to submit your story or bill, you can do it here.)

Sherry Young just wanted to be able to walk without pain.

About three years ago, she began to experience sharp pain in her left foot. Her big toe had become crooked and constantly rubbed up against the adjacent toe, making it painful to run, walk or even stand. "I could not walk without intense pain unless I had a pad underneath my toes for cushioning," Young said.

An orthopedic surgeon told her that he could fix her problem for good. "He thought my foot was hitting the ground too hard and causing pain," said Young. "That's what he was trying to correct."

Jackie Fortier / StateImpact Oklahoma

It’s hard to get basic health care like shots and x-rays in rural Oklahoma. The federal government considers all but one of the state’s 77 counties to have a primary care shortage. The problem is driving a legislative effort to allow highly educated nurses to fill that gap — but doctors and nurse practitioners are butting heads on who is qualified to help.

Lindsi Walker sits behind a glossy wooden desk at Cordell Memorial, a hospital on Oklahoma’s western plains. She’s surrounded by pictures of her family — a stethoscope hangs around her neck.

Richard Klein switched doctors last year. The new doctor put him on a new blood pressure drug.

But it didn't help.

The failure was entirely predictable.

Klein, an associate professor at Florida International University in Miami, realized later that he had tried the same medicine unsuccessfully a few years before, but he hadn't remembered that fact during the appointment.

It was an understandable mistake for Klein and his doctor.

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