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“It’s probably nothing.” That’s what I said to myself not long ago when I started feeling lousy. I should know, since I’m a physician. But I learned the hard way that those “nothings” can get serious fast — and without health insurance, the bill can be astronomical.

Just after Thanksgiving last year, it occurred to me that I was more tired than usual. I chalked it up to working a long string of shifts in the emergency department at the hospital. “I never get sick!” I told myself, and upped my caffeine intake.

About a week later, I started spiking fevers, and my appetite dwindled. Something was wrong but I couldn’t put my finger on it. I convinced myself it was just a virus and would pass with time and rest. But I felt worse over the following week, not better. I continued to convince myself that it, whatever “it” was, would fade away on its own. I thought of the cost of a doctor’s visit, blood tests, imaging, and the rest, then took another Tylenol and went back to bed.


You’re probably wondering why I didn’t simply see a doctor. I’m a bit reluctant to admit it, but I didn’t have health insurance. That’s right — I was a doctor without health insurance.

Earlier in the fall, in the transition from one job to the next, my insurance had lapsed. When I was prompted to sign up for insurance with my new employer, I was told that it wouldn’t go into effect until open enrollment on Jan. 1. I didn’t question that. I was healthy. A few months without insurance would be fine.


A colleague suggested I get covered under what’s commonly called COBRA. But I was flabbergasted by the cost, especially on top of student loan payments and living expenses. I then looked at Covered California, my state’s exchange for Affordable Care Act insurance plans, and was equally dismayed. Knowing my almost pristine health history, I opted to forgo insurance and instead pay the individual mandate penalty, which was a fraction of the cost of coverage.

In other words, here I was talking myself out of going to the doctor — even though I was starting to lean in that direction — because I knew that a hospital bill without insurance would be more than I could handle.

I’m not an anomaly. Many Americans do this every day.

You can probably guess how my story unfolded. When I finally couldn’t put it off any longer, and was barely able to get out of bed, I ended up in the emergency department I work in. A colleague, looking at my chest X-ray showing extensive pneumonia, asked why I waited so long to see a doctor. In tears, I tried to explain.

Later, hospital bill in hand, the explanation became easier.

The bill for my emergency department visit totaled $10,282.34. I had asked that intravenous medications be changed to oral medications when possible because they are less expensive, and refused some additional tests and medications. This kind of insider information, which most people don’t have, helped me keep costs to a minimum — though I was shocked to see a $10,000 bill.

Emergency department bill
The author’s bill for emergency treatment of pneumonia. Courtesy Jessica K. Willett

Consider a single-income family in the U.S. I pick that category because about 1 in 4 children in our country are currently being raised by a single parent, and that number is rising. The average median income for a single-income family is about $35,000. If that parent or caregiver gets sick and needs medical care, how will she or he pay a bill that could be one-third or more of the family’s total annual income? That’s a powerful reason to wait.

We talk about improving access to health care through health literacy, education, and outreach. These things matter. But until we address the cost of health care, a huge barrier to care will remain. Medicine is tightly intertwined with social factors, which affect both physicians and patients — and sometimes, both at the same time.

My story isn’t unique. I now have health insurance, which is a relief to me if similar circumstances arise in the future. Yet I know that many of my patients — and perhaps many of my colleagues — aren’t so lucky. Although I was previously aware of the many social circumstances affecting my patients’ access to care and the circumstances contributing to their overall health, I’m now able to relate to it on a more personal level. Now when I ask the question, “Why did you wait so long to see a doctor?” I can also say, “Yes, I absolutely understand why.”

Jessica K. Willett, M.D., is an emergency physician who works in Northern California.

  • How could you forego COBRA? My oldest child is about to turn 26 in a few months, they have HFA (Asperger’s) and is currently on our policy. “they” work “part time” in retail 40 hours a week. “They” do not have health insurance through their job at the moment, they work in a store as a cashier, etc. I was just quoted a price of $650 a month for COBRA coverage for continuation of coverage. the coverage will stay the same ($300 deductible, $20 copays $25 for specialists, $200 for ER coinsurance 10%). I would never want my child to go without health insurance for one minute. They have had migraines where they ended up in the ER for a few hours (2 hours) and the bill came to $2,000 for an IV to stop the migraine. I would rather pay a few thousand dollars for COBRA while waiting for ins. to kick in (usually you would get covered in 90 days) than to have a “lapse in coverage.”
    As a highly educated person (a doctor!) you of all people should have known this and just put it on your credit card or gotten a loan from your parents or whatever…you’re in the top 1% or higher in education. Never go without coverage if you have potential to make a very good income in your future years which as a doctor you have a fantastic future income potential. I have a few friends who are doctors and they live in million dollar homes, have second homes, drive expensive cars, own boats, etc.
    I wish my own child had been able to go to college as they don’t have much of a future with only a H.S. diploma and social skill deficits as well as migraine headaches which require expensive medications (9 Triptan pills cost $300). The new bio similar drugs such as “Aimovig” cost over $650 a month, etc. (keeping their sex neutral for privacy)….
    Another story, a few months ago my husband had lower left quadrant abdominal pain, saw his primary and was diagnosed with a probable flare up of diverticulitis which he has had before but they didn’t give him a script for a CT scan to get scanned at a radiology facility which would have probably cost about $600 – $1,000. Why they didn’t send him for a CT scan to the nearby facility is a mystery to me. They did give him 2 antibiotics to treat probable diverticulitis. Three days later he started to run a fever in the evening after the doctor’s office was closed. We promptly went to the ER out of fear that there was some kind of a rupture happening and possible sepsis. The ER doctor ordered a CT scan and lots of blood work. The bill came to around $8,000. The ins. company negotiated it down to $6,000. We paid a copay of $200.
    We did later get an “out of network” bill from the ER doctor for $700. I called their billing dept and complained about this bill, they submitted it to our insurance company only after I called them up to complain about the $700 bill for a 5 minute consultation in the ER and he followed up right before they released my husband for about 5 minutes. (they have all kinds of ways to make extra money now apparently). Waiting to see how much they will bill me for after the ins. pays their portion.
    The Insurance company is supposed to negotiate the bill down on the patient’s behalf, if you’re not insured you are out of luck they can charge you as much as they want apparently, if you have any money to your name they will send it to a collection agency and mess up your credit. Only the poor who don’t own anything or make very little money (under about $17,000) can go on Medicaid in states that extended it to single working poor people and get “free” healthcare which is paid for by everyone else who works for a living. Now I am not against giving poor people Medicaid, just the ones who “work the system.” I have a few people I know personally in NY who do this very thing…
    Here is my husband’s ER bill for his diverticulitis flare up:
    4 hr. ER VISIT – AMT CHARGED – $2,231.00 AMT PAID BY INSURER – $1,696.
    CT SCAN – AMT CHARGED – $4,669. AMT PAID BY INSURER – $3,968.
    TOTAL CHARGED – $8,405. DISCOUNT AMT – $1,260. AMT INS. PAID $6,944.25
    There was no abcess/sign of infection in his intestines and they said he showed no signs of diverticulitis in the ER so they discharged him. If we had known that he would have waited another day, went back to the primary and got a script for a scan outside the ER which would have cost much less. We aren’t doctors and don’t know how long to wait so we hurried to the ER when his fever was over 100 degrees fearing the worst, plus he still had abdominal pain in the lower left quadrant, it wasn’t excruciating pain but it was persistent.
    Consider yourself very fortunate that you’re an educated doctor who will always have health ins. unless you lose your job or your medical license (unlikely) for some reason…also, I can’t believe that there is such a long waiting period for doctors to get insurance after being hired, I thought that doctors were in demand. It shouldn’t be more than a 30 day wait for coverage…that was what it was in the “olden days” from what I remember….

    • Did you read what you wrote? Paraphrase, people with low income get Medicaid for free paid for by everybody else who works for a living. Are you high? Then the following says something like you aren’t opposed to giving poor people Medicaid. Well I think you’re a liar. You think people who work but don’t make good money don’t count as people who work. What is wrong with you? Most underpaid poor people aren’t even that ignorant.

    • Fascinating comment… I thought the dr’s article well-written and sensibly acknowledging that high-sky health insurance premiums can cause some to hesitate and others to forego health insurance. Doctors are human! She explained that she was in-between jobs. Obviously other bills (housing, etc.) were likely competing for those same dollars. I’m not sure why John Doe felt the need to criticize the decision though I get that Mr. (Ms?) Doe went to great lengths to ensure their child had insurance.

      As far as the suggestion that the doctor should have just “put it on [her] credit card,” I would strongly disagree. Incurring debt for insurance to cover a possible-but-not-certain health crisis isn’t really smart. I speak as one who did that — for about over year I charged my health insurance premiums on a credit card during a period of low income. How did that help me? It left me strapped with debt. Why not take the approach that I should use my resources (income) to pay what I could, in order of greatest urgency (shelter, food, electricity, transportation, etc.) and recognize that no one can ever fully “insure” against catastrophes? By buying insurance when I lacked the means to do so I essentially strapped myself with unnecessary debt — and here is the kicker: without any real NEED to do so.

      And I’ve done it the other way, too — I fully appreciate that one cannot predict the bills that may arise without insurance. About a decade before, I was uninsured for a period when some unexpected circumstances and marital changes shook up normal life — during that time an equally unexpected health crisis that left me hospitalized for the better part of a week. The cost was high — $10,000 or greater or so if I recall but I was able to qualify for some income-based reduction. Bottom line, I would rather deal with the actual crisis if and when it arose than shell out money I don’t have to go into debt to give an insurance company money that never benefits me at all.

      Please understand – if one CAN afford health insurance, it is a prudent thing to pay for. If someone can go on vacations, pay for a late model car, afford nice clothing and lattes, etc., they probably can finance health insurance. But if someone is working and using their available resources to fund life without enough left over to finance a health insurance bill, I see no reason to criticize them. Just my thoughts, anyway, as someone who has considered this issue.

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