Megan Rothbauer, 29, says she was in a coma and couldn't direct paramedics to the hospital in her insurer's network

By Jeff Truesdell
Updated November 13, 2014 05:25 PM
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Credit: Courtesy Ben Johnsen

At age 29, Megan Rothbauer imagined herself to be the picture of good health and good finances.

Then, on Sept. 4, 2013, she stood up by her desk at her workplace in Madison, Wisconsin – and collapsed.

“I was lucky that I had a couple of colleagues standing right beside me,” she tells PEOPLE. “One of my co-workers caught me. At least that’s what I’m being told, because I don’t remember anything from about four days before that. That’s one of the things that cardiac arrest does – it affects your memory.”

Paramedics rushed her by ambulance to the nearest hospital – St. Mary’s Hospital, which was outside of her insurance network – rather than three blocks farther to Meriter Hospital, where her workplace insurance would have covered most of the cost for her 17-day stay, including 10 days in a medically induced coma.

The result: Rothbauer is staring at bills totaling $41,350, versus the maximum $1,500 out-of-pocket expense she otherwise would have faced, she says.

“I place no blame,” says Rothbauer, now 30, who works as a project manager for a manufacturing company. “Without any of these people I am about to name – without my colleagues, without the ambulance people who spent 45 minutes working on me when they could very well have given up, without the doctors and nurses at the hospital – I would not be here today. They all treated me wonderfully.”

But she adds: “I was unconscious. I had no ability to let anyone know what hospital I needed to be at.”

The financial hole has forced Rothbauer to put her life on hold, delaying her wedding to fiancé Ben Johnsen, while she contemplates bankruptcy.

And her situation is not unique, according to Channel3000.com, which reviewed Rothbauer’s case and found there’s no guarantee that patients won’t be charged higher rates if they receive treatment outside of their insurance network. It’s called “balance billing,” and allows providers who fall outside of a patient’s insurance plan to charge the balance left unpaid by the consumer’s insurer.

“My strong suspicion is this happens more frequently than you think,” Meg Gaines, who runs the Center for Patient Partnerships, a consumer healthcare advocacy group at the University of Wisconsin-Madison Law School, told Channel3000.

Rothbauer is not trying to dodge her responsibilities. Her insurer Blue Cross Blue Shield paid St. Mary’s Hospital 100 percent of its in-network rate toward the initial $258,000 hospital bill – and Rothbauer notes that St. Mary’s subsequently trimmed her remaining charges by 90 percent, to about $10,000. But doctors and specialists bill separately, she says, and that’s where her burden now lies, leaving her with the potential out-of-pocket cost of more than $40,000. (She was originally facing bills totaling more than $50,000, until her insurer processed additional claims.)

In a statement emailed to Channel3000, Scott Larrivee, public relations director for Anthem Blue Cross Blue Shield, wrote that Rothbauer “received care by a hospital that is not in our Wisconsin network. Since we have no contract with this hospital, we have very little influence over what the hospital is charging in this situation.”

Says Rothbauer: “Had I gone three blocks down the road, I would have paid $1,500 for this all.”

“I’ve tried my best to make sure that my finances were in order, and it’s hard to realize that now, because of this situation that was out of my control, they may not be in order. It’s hard to think about the fact that you can’t plan for your future. We have to wait until all of this is resolved to even get married.”

If the bills aren’t reduced and some sort of payment plan eventually is put in place so she can cover her debt, she adds, “that’s a mortgage payment; that’s a chid in daycare. We don’t have kids now, but that’s definitely something we want.”

The good news, she says: “I am great. I have not had another episode since that. I am lucky to be here.”

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