Scott Richardson of Scottsdale, Ariz., stepped out of the shower on Valentine’s Day when he slipped and hit his head on the bathroom floor.
According to the Daily Mail, 65-year-old lawyer passed out due a bleeding ulcer that led to anemia, and was taken to the nearby Mayo Clinic Hospital. Richardson woke up 12 days later only to face a $150,000 hospital bill.
He discovered later that Mayo Clinic was not included in his insurance company’s network, which meant he was responsible for paying out of his own pocket.
“This is not anything anyone would want to go through. It might have been easier if you did not have insurance,” Richardson told azcentral.com in an interview last week. “I don’t remember Mayo. I was in the ICU for almost two weeks.”
His wife Holly said she was told not to worry about medical expenses during her husband’s stay. Doctors told her that even though Mayo Clinic was out of network, they were protected under a federal law called Emergency Medical Treatment and Labor Act (EMTALA), which was passed in 1986.
EMTALA, however, only prevents hospitals from refusing to treat patients who do not have insurance. The law does not force insurers to cover costs health care offered by hospitals outside of their networks, azcentral.com reports.
Blue Cross Blue Shield of Arizona, Richardson’s insurer, paid for most of the bills and sent him reimbursement checks for $30,000. However, he still needs to pay $120,000, which he was told to settle with Mayo Clinic.
Richardson was able to do enough research on EMTALA to believe that he should have been covered.
He said Blue Cross was being problematic with negotiations and representatives were not able to talk about the federal law and how it applied to his case.
Richardson reached out to Call 12 for Action, organized by 12 News, The Arizona Republic and azcentral.com to help people resolve company disputes. Once Call 12 for Action got involved, his $118,000 bill was erased and his out-of-pocket costs reduced to $7,000 – the cost of his deductible.