PARKER, CO—In what doctors are calling a true medical miracle, local construction worker Kal Mathyssen awoke from a week-long coma early Wednesday with the ability to fully comprehend his health insurance plan, sources at Parker Adventist Hospital confirmed.
Mathyssen, who sustained a severe head injury after a fall at a nearby job site, reportedly stunned hospital staff and family members when he suddenly regained consciousness around 1 a.m. and began confidently filling out all the paperwork required by managed care company Aetna to receive the benefits guaranteed by his insurance policy.
“I was online struggling to figure out what is and isn’t covered by our plan, and then Kal just woke up and somehow knew exactly what needed to be done,” said Mathyssen’s wife, Carol, explaining that prior to his coma, her husband had possessed only an average person’s understanding of the process required to file for reimbursement of medical expenses. “Kal was on the phone using words I’d never heard come out of his mouth before—stuff about billing codes, out-of-pocket maximums, and I don’t know what else.”
“As soon as he picked up the claim form and knew exactly what to fill in on the line marked ‘employee group number,’ I knew something was very different,” she continued. “It was just so clear that something had changed inside him.”
According to doctors, within minutes of waking up in the intensive care unit, the 38-year-old began to display an unusually strong grasp of his Aetna Preferred health plan. Astonished onlookers confirmed that after consulting his insurer’s website and listening to a series of recorded messages on a customer service line, Mathyssen determined he would be responsible for a $250 emergency room copay, the amount remaining on his policy’s aggregate family deductible, and the full sticker price of any non-formulary medications he may require during his recovery.
In addition, several of Mathyssen’s family members said they had a difficult time believing that the man who emerged from the coma was the same person they had always known, pointing out that their relative, who has seldom made use of his Health Savings Account in the past, showed a rare ability to determine which bills he would be able to pay for with his HSA debit card and which nonqualified expenses he would have to pay for with his savings or, should that become depleted, through a monthly installment plan.
“In 21 years of practicing emergency medicine, I’ve never seen anything like this,” said Dr. Peggy Adams, who visited Mathyssen during her morning rounds, when the patient reportedly asked about receiving a flu shot and other preventative care procedures his plan covers in full. “It’s impressive that he’s so calm and lucid at this stage, but it’s truly astounding that he knew to ask proactively if the hospital was covered as an in-network facility with his HMO.”
“He even double-checked with the radiologist to make sure his CT scan would be billed correctly in case the insurance company later disputed the claim,” she added. “He certainly came out of that coma with a unique gift.”
Bedside sources said they were left shocked and speechless when Mathyssen later picked up his cell phone and not only reached the person he needed to speak with in Aetna’s benefits department, but also had a cordial conversation in which he appeared to follow everything the representative was saying, ending the call in less than five minutes with a reference number documenting the exchange.
“I’ve tried to come up with an explanation for what caused this, but I’m at a loss, other than to say it’s one of the mysteries of human cognition,” said Adams, calling Mathyssen’s case “one in a million.” “I suppose one minute you can be on a ventilator fighting for your life, and the next you can be entirely aware that your emergency room visit is covered at a different rate than your EMS transfer, and that the latter is billed directly by the ambulance company that 911 dispatched to pick you up. It’s truly remarkable.”
The physician went on to state that she expects Mathyssen to make a full recovery, and that he might one day even gain the ability to understand the paperwork he will need to fill out to file for bankruptcy once he is billed for his hospital stay.