AUSTIN (KXAN) — An Austin teacher is trying to wrap his head around how he’ll pay a $108,951 medical bill following care he received for a heart attack in April of 2017.
Drew Calver, 44, is a teacher and swim coach at Austin High as well as a parent to two children. He said the amount he’s being asked to pay is roughly double his annual salary.
Back in 2017, he’d recently completed a triathlon and wasn’t expecting to be at risk for a heart attack. But he learned after the fact that his genes predisposed him to heart problems.
Calver said the total bill for his four-day stay in the hospital, plus heart surgery, came to $164,941. He receives health insurance through Austin Independent School District administered by Aetna and his health plan only covered $55,840 of that total amount.
Calver’s story was first reported by Kaiser Health News with NPR. The numbers and documents about his billing and medical care were verified by Kaiser Health News.
Calver explained that on the day of his heart attack, he was alone in his home. He was able to contact a neighbor who drove him to St. David’s Medical Center because it was the closest hospital to where they lived.
Calver was sent to the cardiac intensive care unit, and after some tests, medical staff began preparing him for a procedure to put stents in his heart.
He remembers being in the hospital and asking staff whether his insurance would cover the procedure.
“I’m on Seton, my Austin ISD [insurance] is Seton network, I just want to make sure I’m being covered by this,” he recalled saying.
“And they said, ‘Yeah we’ve accepted your insurance, your insurance has been contacted,’ it sounded like they’d said yes,” Calver said, noting at that point he’d checked insurance coverage off his mental list of things to worry about.
Calver’s wife added that hospital staff told them his insurance would be covered regardless of the hospital because it was an emergency situation.
Then around a month later, he saw the bill.
Calver thought it was a mistake. He began spending his free time calling back and forth between St. David’s and his insurance provider to see if there had been an error in how the bill was charged. He and his wife Erin described the process as “like having second, third and fourth jobs.”
In May of 2018 was when Calver said debt collectors began calling him on behalf of St. David’s, telling him he had to pay the amount in full.
“[St.David’s] never worked with us or offered to work with us until August,” explained Erin Calvert. “Until then all we would get would be phone calls saying, ‘You owe us $108,000. Would you like to pay it in one payment or two payments?”
Calvert said that she and her husband would tell these debt collectors that they just couldn’t afford to pay the amount. During those phone calls, Erin Calvert said her family was not even offered the option of financial assistance. The Calverts said they were frustrated by the lack of support and resources to turn to in navigating the complicated volleys of insurance phone calls.
St. David’s HealthCare told KXAN Tuesday that when a patient comes to one of their hospitals, the top priority is to get the patient stable, and afterward staff will check insurance coverage. If St. David’s finds their hospital is out of network for the patient’s insurance plan, they try to transfer the patient somewhere that will take their insurance. But in emergency situations, they are not always able to do so.
Tuesday St. David’s HealthCare told KXAN that they have a financial assistance policy for patients that offers discounts based on patient income. A spokesperson explained that if the Calvers apply for financial assistance, St. David’s estimates the Calvers’ bill would be reduced to $789.29.
Drew Calver said he’d absolutely willing to apply and if that dollar amount is accurate, he’d be relieved to only have to pay several hundred dollars. But he said that is the first he’s heard of that amount and is dismayed that no one with St. David’s communicated that with him. He feels like St. David’s is disregarding the more than a year his family spent in limbo thinking they’d be saddled with a six-figure bill.
“This bill is just as bad as the heart attack,” Calver said.
This back-and-forth has been exceedingly stressful for Calver as he worries if this will dash his ability to support his family and send his kids to college. That, in turn, makes him wonder how his heart is holding up under the anxiety of figuring out this bill.
“I need to focus on staying healthy and preventing another heart attack and reducing stress in my life, and this is doing the exact opposite,” he said.
St. David’s healthcare maintained that it was the limitations of Calver’s insurance plan which led to his large bill.
“While we did everything right in this particular situation, the structure of the patient’s insurance plan as a narrow network product placed a large portion of the financial responsibility directly on the patient because our hospital was not in-network with the patient’s insurance plan,” a spokesperson for the health care system said in a statement.
St. David’s also explained that debt collectors automatically started calling the Calvers, “due to the outstanding balance and because no financial assistance application had been completed by Mr. Calver and received by St. David’s HealthCare.”
The spokesperson for St. David’s also said that between July 2017 and April 2018, St. David’s “was in frequent communication with Mr. Calver about his account.”
But Calver said he struggled to get answers from St. Davids and Aetna about how much he owed or how he could get financial relief during that time. He said he was only told about the financial assistance program in August (though St. Davids said they sent him the paperwork in April 2018 as well).
He also has questions about the costs for his care. For example, the four stents placed in his heart cost around $19,000 dollars each.
“I think it’s important that people realize that even with insurance, it doesn’t mean you’re covered,” said Erin Calvert. “Our system is flawed and it needs to be fixed, because this should not happen.”
“I think that’s why we want to tell our story, because it’s not right,” she added.
KXAN reached out to Aetna, which explained that they only administer claims for AISD who is self-insured.
AISD couldn’t weigh in on Calver’s case specifically out of respect for medical privacy, but they explained that they provide these plans to more than 11 thousand employees.
“Throughout our state and country, the ability to offer low-cost coverage and a variety of options when healthcare costs rise each year becomes increasingly difficult,” an AISD spokesperson noted in a statement. “We balance the ability to adequately contribute to an employee’s benefits with the ability to meet all of the district’s financial obligations including salaries and teacher resources that support student learning.”
According to the Texas Medical Association, insurance companies save money by significantly limiting which doctors and hospitals they include in their networks. TMA is calling for more statewide transparency in this area and advocating for insurance plans to have more hospitals, doctors, and lab services in-network. Their association also pushed to get a bill passed in Texas to allow more patients to enter mediation if they have a disputed medical bill. That bill went into effect in January 2018.
TMA also has resources encouraging patients to protect themselves from surprise bills. A spokesperson for TMA suggested that people should check whether the doctors they’re looking to go to are in-network because the patient will almost always wind up having to pay more for the bill if they go out of network.