The Cost of One Wild Night

ticking clock
The clock read 9:30PM and in front of me was dozens of notes, PowerPoint slides, and practice exams to review before 8AM.

The all-too-familiar finals week all-nighter beckoned, and though I’ve had my fair share of experiences with studying until the sun rose, I decided to forgo the typical mug of coffee and take some over-the-counter caffeine pills instead.

My friend proclaimed that they would help more than any energy drink would. I laid out all my exam materials, popped in a couple caffeine pills, and strapped myself in for a wild night of allopatric speciation and coadaptation. A wild night did ensue, but there was no evolutionary biology involved.

Around 11:30PM, what could only be described as the worst headache of my life, detracted me from my desk and led me to the bathroom floor. I decided something needed to be done. Student services at the university health system were closed, so that only left me with the ER as an option.

An ER visit was outside the coverage of my standard student health insurance provided with tuition and I didn’t have a personal health insurance plan. I was wary of any costs that I might incur in the ER.

Instead of an ambulance, my best friend, Eric, drove me to the hospital.

My face remained scrunched and my head continued to pound as Eric and I sat in the waiting room. When we were finally admitted, I listed my symptoms: “headache like I’ve never felt before”, vomiting, and bright light intolerance.  The resident physician suggested meningitis or a brain aneurysm. He needed to run some tests to check the possibilities.

It was 3AM when I called my mom, telling her that I was in the hospital, asking her what I should do knowing we didn’t have insurance. She yelled, “Let them do whatever they need to do!” Knowing mothers are worriers, I asked the doctor what the pitfalls of not getting the tests were. He simply said, “Worst case scenario is that you die”. My friend said without reluctance, “Dude, don’t die.”

I was carted off for a CT scan. Afterwards, the resident physician outlined the steps of a spinal tap and explained how the results could help determine whether aneurysm was in the picture. He missed his target three times; I was lucky enough to have a 7-inch needle jammed into my back multiple times!

After I jerked and shrieked as some sort of spinal nerve was struck, the attending physician stepped in and completed the diagnostic procedure on his first try.My friend stepped out after the first needle puncture. He mentioned later that he got a little sick seeing the needle thrusting in and out. The lumbar puncture experience was terrible, but not as terrible as the bill that was to come later.

My eyes bulged at the $8,000 amount due at the bottom of the bill. Multiple service items with astounding amounts were listed. I knew hospitals had to be reimbursed for their services, but I had no idea that a simple IV saline hookup would cost me hundreds of dollars! Had I known gold was flowing into my veins, I might have declined the second IV bag as the first one ran empty.

I also didn’t know that a simple CT scan and diagnostic procedure would cost thousands!

What started out as a possible brain aneurysm, turned out to be a bad migraine. The migraines continued as any movement more than 20 yards during the next week would cause me to get sick and vomit. Had I known I was going to owe $8,000 for one night in the ER, I would have waited until the next morning when I could have visited the student university health department, free of charge.

I ended up doing that a couple days after my ER visit anyways and that’s where they figured out what the ER folk couldn’t. They gave me a prescription for some vasopressin to help with my migraines and sent me on my merry way. The drugs helped and my migraines haven’t returned since.  What didn’t help was the $8,000 bill that was added to my already growing debt from student loans.

Sammy Ta, MPH was a contestant in the 2013 Costs of Care Essay Contest.  This piece originally appeared in Costs of Care

10 replies »

  1. Ever since the “affordable” care act came about, my insurance premium has doubled and my deductible has gone for 1k to 5k. So basically I avoid the ER at all costs because we know how much they charge, I think just $750 to walk in the door. I use urgent care near my house but I don’t feel they are as reliable. I miss being able to go to the doctor when I’m sick or hurt. This new insurance has not allowed me to do that unless I want to pay 4 times the amount in premiums. Ridiculous! http://www.bestbackpackblower.org/

  2. Note to Mary — thanks for your comments.
    But this shows with great clarity why we need all-payer regulation on hospitals.
    My preference would be for a basic law that ER charges can be no more than 125% of Medicare for the same diagnosis.
    Because we have no President or Congress with the courage to enact this, we force individual patients to struggle greatly.

    About 5 states do have laws that restrict hospital bills for persons with incomes below about 259% of poverty. Many hospitals do forgive charges for persons who are poor but do not have Medicaid.

    But the incredible cruelty and price gouging goes on for persons who make a little too much money for these protections.

  3. Another alternative would be to try to negotiate the bill to something bordering on reasonable. This is best done within 30-45 days of getting the bill. Most hospitals give a 25% -50 % discount on bills that are paid in full within a short time.
    I had a laparoscopically assisted hysterectomy with removal of ovaries, tubes, and a roughly 10 cm diameter mass in the left adnexal region. The mass was benign; there was early invasive stage 1 low grade endometrial carcinoma. The surgery was uncomplicated, as was the recovery. I spent just under 16 hours at the hospital. My total bill (including surgeons, anesthesiologists, radiologist) was slightly more than $91,000, or $5687.50 per hour. I stayed about 6 hours longer in recovery than I otherwise would have because I was having difficulty passing urine.
    After much research, I determined that Medicare would have allowed charges of roughly $10,000 for the procedure. I asked around for advice and then proposed to the hospital that I could either pay $20,000 immediately and satisfy my financial obligation to the hospital entirely, or I could do interviews with the “financial counselors” and pay on time. I noted that I don’t believe my life expectancy would be long enough for me to pay the bill even if I paid $ 500/month. The hospital took the cash in hand.
    It’s impossible to know how much various insurance plans would have paid the hospital since the insurance companies consider this to be proprietary business information. Even the medicare figures were hard to find (by a fluke, I got information intended for surgeons and provided by a manufacturer of surgical supplies).
    During the pre-surgical work-up, I had a CT scan at a community hospital which was read by the local radiologist, and for which I paid approximately $ 300. I had my surgery at a tertiary hospital; the CT scan was read again by their radiologist with a charge of roughly $ 900. My preoperative EKG and chest X-ray were charged at about $ 350 each (not including physician charges to interpret the studies). I recently reviewed records for a patient who had been treated at an urgent care facility. These records included a billing sheet which was used for uninsured patients and had pre-printed prices by each of a number of services. Neither study was billed at over $ 60!
    I think the wild variation in charges is a big part of the problem of excessively costly medical care. Unless this is addressed and rates are changed to something in line with costs to provide care, changing who pays for insurance won’t help a bit.

  4. Agree with Perry, et.al, that when the young healthy patient presents to the ER with the “worst headache of my life” and photophobia/vomiting, he is basically stating “I’m here to get my CT scan and LP.” This is not only appropriate medically, but from a risk management standpoint, almost has to be done.

    I feel badly for Sammy that:
    1) the resident goofed on mult attempts with an LP. I’m pretty good at them, but like every other doc, I had to learn somehow. Teaching point #1 for Sammy: next time you have to go to the ER, choose the upscale suburban one UNLESS your femur is sticking through your skin.

    2) the CT cost too much. Can’t argue that one. CT’s have been around 40 yrs but unlike CB radios, Tv’s, DVR’s, etc., the cost keeps going UP instead of down. Maybe the CT was actually invented by Steve Jobs, that might explain why we need to get new ones every 2 yrs and the cost keeps going up. Teaching point #2 for Sammy: at least tell the ER you DON”T need contrast, which doubles the cost of the CT and adds nothing.

    3) The ER bill was astronomical. Agree with good advice above from Ms. Swift, he may be able to reduce his charges if pleading indigency. Teaching point #3 for Sammy: see Ms. Swift’s note above. If you have a pal in law school, he/she may can help you on your letter to the hospital

    4) Too many patients without health insurance. Unfortunately, giving everyone insurance (whether via the ACA or otherwise) will STILL result in huge ER bills. Why? have you seen the deductibles and max OOP costs with any of these health exchange plans? Sammy’s bill was $8,000, and his out of pocket and deduct for most of these are at least $6,000-$7,500. So much for health insurance (too bad, Mr. Hertz) – Sammy is still out a semester’s tuition. Teaching point to all: let’s slip Obama some caffeine pills . . .

  5. About five states have laws which do restrict ER bills to more or less Medicare rates for uninsured or underinsured persons under 300 per cent of poverty.

    It is repulsive to me that this has to happen on a state by state basis rather than federally.

    The Obama admin would respond that their solution is to get everyone insured. Let’s see if that works.

    Bob Hertz, The Health Care Crusade

  6. Sammy should contact the hospital social services department/person and work on negotiating down this debt or possible complete write-off due to inability to pay. Definitely get on a payment plan. Even if you do have insurance, it’s not unusual to have monthly doctor/hospital payments anymore.

  7. Perry is correct…elimination of possibilities is the proper protocol…for medical, ethical and liability issues. A key question is how much of that $8,000 would an insurer or Medicare have paid…not $8,000. If he was given a “charges” bill…and expected to pay up…he would be obligated for $8,000. A payer would probably pay about half of that amount. Which is another subject for discussion.

  8. “When we were finally admitted, I listed my symptoms: “headache like I’ve never felt before”, vomiting, and bright light intolerance.”

    Sammy, I understand your consternation over the huge hospital bill. However, any physician in their right mind can not afford to overlook the possibility of an aneurysm once the phrase “worst headache of my life” has been used. In a court of law, using a financial reasoning for not ordering a potential life-saving test will not endear you to a jury.
    Such is the system that we practice in. We are held accountable for life and limb, and now also for spiraling health care costs. It is one thing to miss a small fracture, but another altogether to miss a cerebral aneurysm.
    While we are now considering people having insurance will make things better, I still don’t see the costs of ER care and CT scans coming down. Hospitals are more than happy to have itchy, lawsuit averse ER doctors ordering tests out the wazoo, they make lots of money that way.