When Drew Calver, a high-school teacher from Austin, Texas, suffered a sudden heart attack, he was rushed to an in-network hospital and underwent life-saving surgery. Weeks later, he received a devastating surprise: a $109,000 bill from an out-of-network assistant surgeon he never met.
The Administrative Trap: In-Network Hospital, Out-of-Network Doctor
The assistant surgeon involved in Drew’s emergency surgery was out of network, even though the operation occurred entirely in an in-network facility. His insurer covered only a small portion, leaving Drew responsible for the remaining balance in a practice known as balance billing.
Legal Insight: The No Surprises Act
Under the federal No Surprises Act, effective January 1, 2022, patients are protected from receiving surprise medical bills for emergency care or for out-of-network clinicians operating within in-network hospitals.
Outcome and Lesson
Public outrage surrounding Drew’s case ultimately pressured the hospital and physician to drop the entire $109,000 bill. His story became part of the national momentum that pushed for passage of the No Surprises Act.
What You Can Do
If you receive a large unexpected medical bill for services at an in-network facility, do not pay it before contacting your insurer and invoking the No Surprises Act. You may also file a federal complaint through the official portal.
Sources
- NPR & KHN: An Out-Of-Network Emergency Left A Teacher With A $109K Bill
- CMS.gov: No Surprises Act Consumer Protections
- Consumer Reports: How the No Surprises Act Can Protect You
