{"id":450,"date":"2025-05-29T09:00:00","date_gmt":"2025-05-29T09:00:00","guid":{"rendered":"http:\/\/www.dangeladvertising.com\/?p=450"},"modified":"2025-05-30T15:15:00","modified_gmt":"2025-05-30T15:15:00","slug":"a-medicaid-patient-had-a-heart-attack-while-traveling-he-owed-almost-78000","status":"publish","type":"post","link":"http:\/\/www.dangeladvertising.com\/index.php\/2025\/05\/29\/a-medicaid-patient-had-a-heart-attack-while-traveling-he-owed-almost-78000\/","title":{"rendered":"A Medicaid Patient Had a Heart Attack While Traveling. He Owed Almost $78,000."},"content":{"rendered":"

On Christmas Day at the WaTiki indoor water park, Hans Wirt was getting winded from following his son up the stairs to the waterslides.<\/p>\n

Wirt\u2019s breathing became more labored once they returned to the nearby hotel where they and Wirt\u2019s girlfriend were staying while visiting family in Rapid City, South Dakota.<\/p>\n

Then he grew nauseated and went pale. Wirt thought the cause might have been the altitude change between his home in Deltona, Florida \u2014 33 feet above sea level \u2014 and Rapid City, at the edge of the Black Hills. But his 12-year-old son was worried and called for an ambulance.<\/p>\n

\u201cI could tell by the look in his eyes that there was something a little more to this,\u201d Wirt said. \u201cSo I can kind of thank my son for saving my life.\u201d<\/p>\n

It turned out the 62-year-old was having a heart attack. A \u201clousy Christmas present,\u201d Wirt said.<\/p>\n

Medics stabilized Wirt before taking him to Monument Health \u2014 the only hospital in Rapid City with an emergency room \u2014 where he was treated over two days.<\/p>\n

Then the bill came.<\/p>\n

The Medical Procedure<\/strong><\/p>\n

Paramedics used a defibrillator to restore a normal heart rhythm. Doctors at the hospital gave Wirt various medications, used an electrocardiograph\u00a0and other diagnostic and monitoring devices, and inserted stents into his arteries to improve blood flow to his heart.<\/p>\n

The Final Bill<\/strong><\/p>\n

$95,523.73, including $32,998.90 for medical supplies, mostly related to the stents, and $28,879 for treatment in a cardiac catheterization lab. After unspecified hospital adjustments to the bill, Wirt owed $77,574.44.<\/p>\n

The Billing Problem: Medicaid Across State Lines<\/strong><\/p>\n

Wirt is covered by Florida\u2019s Medicaid program through Sunshine Health, a managed-care plan. But the South Dakota hospital refused to submit the bill to his out-of-state Medicaid plan, instead sending it to Wirt and eventually threatening to send the debt to a collection agency.<\/p>\n

Medicaid, the government health insurance program primarily for low-income people and those with disabilities, is jointly funded by the federal government and states. States are responsible for administering Medicaid, and most contract with private insurance companies like Sunshine Health.<\/p>\n

Federal law<\/a> says state Medicaid programs must reimburse out-of-state hospitals for beneficiaries\u2019 care in an emergency.<\/p>\n

Many hospitals bill out-of-state Medicaid plans in such situations. If they don\u2019t, they risk not being reimbursed at all, since Medicaid recipients probably won\u2019t be able to afford large bills, said Katy DeBriere, who was legal director for the Florida Health Justice Project when she spoke with KFF Health News in April.<\/p>\n

But there\u2019s no federal law that requires them to do so, she said.<\/p>\n

Federal court opinions<\/a> have noted that hospitals<\/a> are not required to bill Medicaid for every individual beneficiary they treat, even if they generally accept Medicaid.<\/p>\n

Monument Health didn\u2019t bill Wirt\u2019s insurance because the hospital isn\u2019t enrolled as a health care provider with Florida Medicaid, said hospital spokesperson Stephany Chalberg. She told KFF Health News that Monument bills Medicaid plans only in South Dakota and four bordering states: Wyoming, Montana, Nebraska, and Minnesota.<\/p>\n

The hospital\u2019s website says<\/a> Medicaid patients who are not enrolled in one of those states \u201care responsible for any charges.\u201d<\/p>\n

<\/p>\n

\u201cDue to the significant credentialing requirements of our multiple hospitals and hundreds of physicians we do not participate with all states,\u201d a hospital representative wrote in a message to Wirt.<\/p>\n

According to Florida\u2019s Medicaid website<\/a>, out-of-state providers who have treated one of its enrollees must submit five documents to bill the program, including a six-page application, a copy of the provider\u2019s license, and a claim form.<\/p>\n

The process is different in each state, and many Medicaid programs reimburse out-of-state providers at lower rates than those that are in-state, according to<\/a> the Medicaid and CHIP Payment and Access Commission, a federal agency that advises Congress.<\/p>\n

\n\t\tMore from this series\t<\/h4>\n