Neighbors Champion Legislation Fighting Balance Billing

Originally published in the May 2019 Flea

The Flea spoke with Erin Calver about her family’s experience with a surprise medical bill and recent experiences speaking out in favor of legislation currently working its way through the Texas Legislature.

In April 2017 Drew Calver, an Austin High history teacher, was home in Cherrywood when he had a heart attack. A neighbor rushed him to St. David’s Medical Center’s ER, and he was admitted to the cardiac unit for treatment. St. David’s bill for the surgery and hospital stay was $164,941, of which his insurer paid $55,840. Drew received a bill for the balance of $109,101. Only after NPR/ Kaiser Health Network published a story by Chad Terhune featuring him did St. David’s reduced the charges to $782.

The Flea: Prior to Drew’s heart attack, had your family had any experience with surprise billing?

Erin: No. But we quickly learned that Drew's AISD health insurance is a “narrow-network” plan, offering little coverage outside its network. So, for us in a cardiac emergency, when we needed health insurance the most it didn't protect us. Once we got national attention and our medical bill was taken care of, we very relieved. [But] we had heard stories, specifically about other AISD teachers, who have emergency room bills from St. David’s. We realized that sharing our story was a powerful tool to help others.

The Flea: How did you connect with the Center for Public Policy Priorities?

Erin: Through a Cherrywood neighbor! CPPP has been working on this issue for 10 years. Our neighbor went to graduate school with Stacey Pogue, CPPP’s senior policy analyst. Stacey reached out to us asking if we wanted to meet with Senator Hancock [R-North Richland Hills], co-author of SB 1264. We spoke to Sen. Hancock about our story and attended the press conference. Then, we were asked to speak at the Senate committee hearing. It was an eye-opening experience with lots of industry groups lobbying their interests. It was a scary moment as it looked like the patients’ stories were getting drowned out. But on April 2, the second anniversary of Drew's heart attack, it made it out of committee (7-2)!

The Flea: What exactly does the current bill propose?

Erin: Senate Bill 1264 removes patients from disputes between insurance companies and providers in situations where patients have no choice, like medical emergencies. Patients will only be accountable for their copay and deductible. The hospital cannot “balance bill” the patient. It establishes an arbitration process between the hospital and insurance company, taking the patient out of the equation.

The Flea: Why do you think this political moment in time coupled with a powerful story like yours is what’s moving this issue forward?

Erin: I believe Drew's story resonated with a lot of people for two reasons. First, he was a healthy person who suddenly collapsed from a life threatening heart attack, but also the fact that so many Americans have dealt with unforeseen, overwhelming medical bills. Unfortunately, our health care system is a nightmare that many people know all too well.

The Flea: What do you hope comes next?

Erin: Besides SB 1264, there is also SB 1530 that allows self funded insurers to opt into the arbitration program. If this bill passes it will help a lot of people whose health insurance is self-funded, like AISD, the next step would be an awareness campaign. Also, because ultimately this needs to be fixed on a federal level, Congressman Doggett has proposed a bill to stop the practice of balance billing. Hopefully healthcare will take center stage again, and Congress will move on the issue.

James Reed