A Holiday Heart Attack and a $78,000 Medical Surprise: One Man’s Medicaid Nightmare Across State Lines
On Christmas Day, Hans Wirt was doing what many parents do—chasing his 12-year-old son up the stairs at the WaTiki indoor water park in Rapid City, South Dakota. But halfway through the festive fun, Wirt found himself breathless. Back at the nearby hotel where he was staying with his girlfriend, things got worse—his breathing was labored, he turned pale, and nausea set in.
Wirt, 62, thought the elevation change from his hometown of Deltona, Florida (a mere 33 feet above sea level), to South Dakota’s Black Hills might be the culprit. But his son noticed something wasn’t right—and made the lifesaving decision to call 911.
“He could tell by the look in my eyes that something was off,” Wirt said. “Honestly, I owe him my life.”
It turned out Wirt was having a heart attack—a frightening and unexpected “gift” on what was supposed to be a joyful holiday. Medics stabilized him and rushed him to Monument Health, the only hospital in Rapid City with an emergency room. He spent two days receiving urgent, lifesaving care.
A Shocking Bill Arrives
Doctors at Monument Health administered multiple medications, used a defibrillator to restore his heart rhythm, inserted stents to improve blood flow, and ran diagnostic tests. Wirt survived—but the bill was nearly $95,000. After hospital discounts, he was left with a balance of $77,574.
The problem? Wirt was covered under Florida’s Medicaid program, through Sunshine Health. But Monument Health doesn’t participate in Florida Medicaid and refused to file the bill with his insurance provider. Instead, they sent it directly to Wirt—eventually threatening to send the debt to collections.
When Medicaid Stops at the State Line
Medicaid, a joint federal and state program, provides health coverage for low-income individuals, families, seniors, and people with disabilities. Federal law requires Medicaid to cover emergency services even when patients are out of state. But in practice, there are gaps. Hospitals aren’t required to bill out-of-state Medicaid plans, and the paperwork involved often deters them from doing so.
Monument Health confirmed they only bill Medicaid programs from South Dakota and four neighboring states. For everyone else? “You’re responsible for the charges,” their website states.
According to Wirt, he reached out to the hospital to explain he couldn’t afford the bill. “They didn’t offer me help. No financial aid info, no charity care details, nothing. Just a payment plan I couldn’t possibly afford,” he said. “There’s a reason I’m on Medicaid.”
Sunshine Health, his Medicaid provider, told him they couldn’t accept bills submitted by patients—only directly from providers. Though they said they contacted the hospital on Wirt’s behalf, the help ended there.
A Quiet Resolution After Public Attention
After Wirt’s story was shared with KFF Health News, something unexpected happened. The bill, which had loomed at more than $77,000, suddenly vanished.
Monument Health covered the entire amount through its charity care program—an internal initiative meant to help patients unable to pay. A spokesperson for the hospital said eligible patients are considered before accounts are sent to collections, but Wirt insists no one ever mentioned the program when he asked for help.
“I felt like I was on my own,” he said. “I didn’t want anyone else to go through what I did.”
Lessons from the Medicaid Maze
Legal experts say Wirt’s experience exposes a deeper issue within Medicaid’s state-based system. Sarah Somers, legal director at the National Health Law Program, said, “There are many moving parts in Medicaid, but in this case, none of them moved to help Hans.”
Advocates recommend that patients who receive out-of-state medical bills:
- File a complaint with their state Medicaid office.
- Contact their managed-care plan, if they have one.
- Reach out to legal aid or consumer protection groups specializing in medical debt.
- Ask hospitals to apply for charity care or enroll as an out-of-state Medicaid provider.
“It’s unrealistic to expect a low-income patient to navigate all this alone,” said attorney Katy DeBriere. “The system is supposed to protect people like Hans, not bury them in debt.”
The Final Word
Wirt praised the care he received at Monument Health but hopes his story raises awareness. “I want to make sure the next person doesn’t get stuck with a $77,000 bill after surviving a heart attack,” he said.
He added with a wry smile, “If I’m going to get sick again, I better make sure it happens in Florida.”