Chapter 7 - Solutions for a Financial Crisis » Chapter 7 Bankruptcy

The Stamford Times, pulling from the Washington Post, carries the story of Josh Lemacks and the amazing battles this kindergartner and his parents have already had to fight for his well being – bodily and financially.

While still in the womb, doctors detected a rare heart defect in Josh that would require several complex and urgent surgeries. The surgery is uncommon, and the Lemacks family looked for more experienced surgeons outside of their regular care network.

Although they live in Virginia, the Lemacks found a skilled team in Philadelphia soon enough and were able to explore their coverage options with their insurance company, Anthem Blue Cross and Blue Shield of Virginia.

The two surgeries Josh needed, which involved reconstructing the aorta, still left him with only a 5 percent chance of survival.

There was elation and then there was heartache. From the story:

The initial surgery in 2003 was a success. But what the relieved parents didn’t realize was that their financial life would be drastically impaired. They ended up with $70,000 in doctors’ bills that their insurer, Anthem Blue Cross and Blue Shield of Virginia, refused to pay – even though it had approved the couple’s choice of surgeons. After the second surgery, they were responsible for $15,000 more. Debt collectors have been calling ever since.

The discrepancy came about because of what’s known as “balance billing.”

When a doctor, hospital or lab tech charges more for a procedure than an insurance company will pay, the patient will sometimes be stuck paying for the difference. This is a balance bill, and these medical bills can add up quick.

Most often this happens if you seek care with an out-of-network hospital or doctor where your insurance company hasn’t negotiated rates. But sometimes you may not have a choice. From the story:

For patients who voluntarily chose an independent caregiver over in-network options, the additional bills, while often unwelcome, are generally considered justifiable. But consumer advocates want the government to protect people who unwittingly end up out of network because of an emergency, such as when they are taken to the nearest hospital after a car crash; or who get an insurer’s permission to see a specialist out of network; or who were unknowingly treated by out-of-network doctors while at an in-network facility.

In the Lemacks case, they received care at an in-network hospital from an out-of-network doctor and his team. The family was still stuck with massive bills even though they did work up front, including obtaining letters and recommendations from doctors and the insurance company, to ensure they would be covered.

While the Lemacks were able to negotiate for reduced medical bills with some medical providers, they are still deep in medical debt. But there is a light at the end of the tunnel, and their son Josh is as happy and healthy as other children his age.