A Christmas heart attack far from home

On Christmas Day, 62-year-old Hans Wirt was enjoying time with his son at the WaTiki indoor water park in Rapid City, South Dakota. But what began as holiday fun quickly turned into a life-threatening emergency. After climbing stairs to reach the water slides, Wirt became short of breath, then pale and nauseated. His 12-year-old son called for help.

Wirt, a resident of Deltona, Florida, was rushed to Monument Health, the only ER-equipped hospital in Rapid City, and was treated for a heart attack. Medics used a defibrillator, and hospital staff administered medications, ran diagnostics, and inserted stents to restore blood flow. After two days of treatment, Wirt stabilized — but his relief didn’t last long.

A $95,000 bill, and Medicaid won’t cover it

When the bill arrived, the charges totaled $95,523.73. Even after some hospital adjustments, Wirt was left owing $77,574.44.

The reason: Monument Health refused to bill Wirt’s insurance, Florida’s Medicaid program through Sunshine Health. Individual states administer Medicaid, and while federal law requires state Medicaid plans to cover emergency care across state lines, hospitals are not legally obligated to submit those bills.

Monument Health’s explanation? They are only enrolled to bill Medicaid in South Dakota and its four neighboring states — Wyoming, Montana, Nebraska, and Minnesota. The hospital said the bureaucratic burden of enrolling with other state Medicaid programs was too high.

The system fails, and the patient is stuck

Wirt tried to handle the billing himself, but Sunshine Health told him it only processes claims submitted directly by providers. Although the insurer stated that it had contacted the hospital on Wirt’s behalf, no resolution was reached.

“I’m on Medicaid for a reason,” Wirt said. “It’s just beyond me how they can expect somebody who had Medicaid to come up with that kind of money. It’s unrealistic.”

According to experts, hospitals aren’t legally bound to register with out-of-state Medicaid programs, and many don’t bother. Federal law doesn’t require it, even for emergency care. That leaves patients in an impossible position: legally entitled to coverage, but unable to access it.

A sudden reversal — and zero balance

After KFF Health News began asking questions, Wirt noticed his bill had dropped to $0. Monument Health said it had applied its charity care program to cover the full balance.

The hospital said it screens “appropriate patients” for financial assistance before sending bills to collections. But Wirt said that when he initially explained his financial limitations, Monument Health staff didn’t mention the program or offer help beyond suggesting an unaffordable payment plan.

Experts: Medicaid failures are systemic

Legal experts say Wirt’s case is not unique, and that similar billing nightmares are common for Medicaid patients who need out-of-state care.

“The various cogs in the Medicaid system didn’t operate correctly,” said Sarah Somers of the National Health Law Program. She emphasized that state Medicaid offices, managed-care providers, and hospitals each bear some responsibility.

Katy DeBriere, formerly with the Florida Health Justice Project, said legal aid groups can intervene in such cases and demand hospitals either bill Medicaid properly or grant charity care. “Nobody’s exerting themselves enough to just smooth the way for this person,” she added.

The takeaway for Medicaid patients

If you’re on Medicaid and receive a surprise medical bill from out-of-state care, experts advise:

• File a complaint with your state Medicaid agency and your managed-care plan
• Ask about assigned caseworkers who can intervene on your behalf
• Contact a legal aid clinic or medical debt advocate
• Request that the provider either enroll with your state Medicaid or apply charity care

As for Wirt, he’s grateful for the medical treatment — and his son’s quick thinking — but wary of traveling again without being close to home. “If I get sick and have a heart attack,” he said, “I have to be sure that I do that here in Florida now instead of some other state.”

This article Florida man gets $95,000 bill after out-of-state heart attack — then a surprise resolution appeared first on BreezyScroll.

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