On Tuesday, we heard from a New England emergency room nurse about his view on the problems with the healthcare system. We talked about the number of patients he has who need primary care, not emergency care, and how the issue of cost impacts his care for patients—like when ambulance dispatchers ask him for a credit card number over the phone.
Today, we’re going to hear about his experience on the other side of things, as a patient. His infant son got a random infection, leading to Toxic Shock Syndrome—and a $6500 bill, because the hospital was out of network. The nurse shared the hospital bill with me, and half of it was simply categorized as “Other.” (The hospital doesn’t have to give you a more specific itemized bill unless you ask for it.) He’s still paying it off. At this rate, he’ll be done in about seven years.
One important thing here is that even emergency room nurses, who are not the worst-paid people in society (as our nurse here said himself), and who have intimate experience with illness and how quickly things can go south, end up making decisions like this. Wait it out, hope for the best. A nurse’s baby ends up in septic shock because the cost of care is so high, because the bill is going to be more than they have in their whole savings account.
(The baby is now a healthy and happy toddler.)
It reminds me of this story reported by Sarah Kliff, about a mother who sat with her toddler in the parking lot of an emergency room, waiting to see if her possibly poisoned toddler got sick. In that case, the kid was fine, and they drove away, avoiding a big bill. In this case, the parents got unlucky; they had to take their son in, because he really was sick, and they got stuck with a $6500 bill because of it. In either case, it could have gone the other way. Fate decides whether or not you deserve to be thousands of dollars in debt or not.
The other thing to note is that the hospital this nurse went to, which he chose because he knew it was a high-quality children’s hospital from his work at its sister hospital for adults, was out-of-network. A lot of healthcare coverage focuses on the patients who got “surprise bills,” those who diligently went to the in-network hospital but, Through No Fault Of Their Own, were seen by an out-of-network doctor. Those situations are obviously insane and outrageous.
But is it that much better if a patient gets a $6500 bill for keeping his baby alive at a different hospital? Does this nurse deserve to be paying off a bill for years because he chose a hospital he knew and trusted, instead of pulling up his insurance website on his phone while his son spiked a fever? The problem isn’t just the patients who did everything ‘right’ and got shafted; the problem is insurance networks, inflated hospital charges, and the existence of medical bills, period.
As the nurse told me, all of this really underscores what a lie the notion of ‘choice’ in health insurance is. “Look at all this choice I have with my health insurance, I can go to this doctor, or that doctor—just not that doctor.”
Anonymous Nurse: I had been working at a downtown Providence hospital. Me, my fiancée and my son, we bought a house and moved out from Providence to the western part of the state and I got a new job out here. About a week, two weeks after that, I came home from work one day, and [my son] had this red rash around his mouth. And we didn't really know what it was, but we gave him some Benadryl, it didn’t seem like an allergy or anything.
So we put him to bed, and the next day he was red all over, he was, like, covered. We sat around all Saturday—now, meanwhile, in the back of my mind the entire time it’s like, we can’t go the emergency room, because we don’t have the money to pay for a hospital bill. So in the back of my mind the whole time is, like, do everything to make sure that we can just go to the doctor on Monday. Go to the doctor’s office on Monday, he’ll be fine.
Saturday, we kinda just watched him closely, he wasn’t that sick, but this rash was spreading all over his body. It was covering his entire body. Sunday, we woke up and he was starting to swell, not swollen but he was edematous, like fluid, little blisters. He spiked a fever too, this is the first time he had gotten a fever.
So finally I was like, we need to go to the emergency room, and we drove back to Providence because they have a really good children’s hospital. And when we got there he had low blood pressure, his heart rate was wicked high, he was in septic shock. And I had no fucking clue—but part of me did have a clue. We would have never gone. That’s one of the things, emergency room nurses are like, I will never go to an emergency room in my life if I can avoid it. The whole struggle, the whole time was obviously evidence that I knew he had something seriously wrong with him.
So he was in septic shock when we got to the hospital, and he had to stay in the hospital for a couple days, and at the end of all that, it’s no big deal, because he’s better really quickly. We still don’t really know what happened, he had Toxic Shock Syndrome, which is usually from a staph infection, which in little babies can fly out of control really quickly. But he didn’t have any obvious site of infection or anything.
We went to the hospital that I used to work at, it’s all one system, the adult and the children’s hospital are connected under one umbrella. Two weeks before, I would have given them a hundred dollars because I worked for them and that would’ve been my emergency room co-pay—which is fucking crazy to begin with, because I work there and they’re still charging me $100 and I’m thankful for it.
But instead I get a bill for $6500 at the end of that, which was just like, out of pocket maximum for my new health insurance. And it was because it was an out-of-network hospital for my new insurance—instead of going to Providence, I should have gone to Worcester, Massachusetts.
Sick Note: How are you supposed to know that?
Anonymous Nurse: And like, how am I even supposed to care? That’s kind of the whole bullshit of our system, is that like—look at all this choice I have with my health insurance, I can go to this doctor, or that doctor—just not that doctor.
So I work out a deal where—I wouldn’t say we’re poor here, I’m an emergency room nurse, I make decent money, but my fiancée is a stay-at-home mom. So we own like a small two-bedroom house, and $6500 is more than we have in savings, in a savings account for emergencies. And I’m also just like, I don’t feel they’re entitled to that much money. So I worked out a deal where I’d give them $50 a month and I just… do that, but it’s like, that’s never going to go away. You’re never going to pay off that debt at $50 a month.
And all it does is just, get me peace of mind that they won’t take me to court or something, you know.
Sick Note: When you get that bill, and you talked to them about it—how did that negotiation go?
Anonymous Nurse: I didn’t qualify for financial assistance from them, for the crime of being too wealthy. I was just like… I can work out a monthly payment. And they’re like, ok, so we request that you pay 20 percent of the bill upfront—they make all these requests that they know they’re not empowered to enforce or anything, they just hope you’ll agree to it. And I just didn’t, and I just kept telling them, I’ll give you fifty dollars a month. And eventually that’s where we landed.
Thanks again to this nurse for sharing his story. If you have a healthcare story, email me at firstname.lastname@example.org.