On Thanksgiving evening my baby spiked a high fever. By Friday morning her little head started bobbing up and down as it became hard for her to breathe. My daughter had an infection and she was in respiratory distress.
We rushed to a pediatric emergency room where the doctors recommended that she be admitted to their hospital’s intensive care unit. Because we ended up at a hospital that was considered “out of network” by my insurance plan, I called the number on the back of my insurance card to make sure the emergency admission was OK. To my horror, the office was closed and would not re-open until Monday.
Exhausted by illness and overwhelmed by her medical care, my daughter became momentarily unresponsive to my voice and my touch. This was one of the scariest moments of my life, and it was made even more devastating by the specter of a medico-financial misstep.
I would have preferred to stay put and avoid any delays or complications to my baby’s care, but I knew pediatric ICU admissions were devastatingly expensive, and can cost over $3,500 each day. I used my cellphone to download and review my policy benefits, but I couldn’t think clearly enough to weed through the layers of fine print.
As a new mother, I didn’t know what to do. As a doctor, I also didn’t know what to do, because what I had been taught to do turned out to be wrong.
I knew better than to consent to treatment without asking questions first.
As a medical student at the University of Virginia, I remember encouraging my ER patients to accept the hospitalizations that they needed. When they, too, worried about the cost of care, I parroted a line I’d learned from residents and attendings throughout my training: “Don’t worry, the financial office will help you with that.”
But for these patients there was no help. After accepting care from UVA, the hospital system billed patients like mine and then sued them for an inability to pay, seizing the homes of some and bankrupting others.
Aiming to avoid a financial trauma of my own, I knew better than to consent to treatment without asking questions first.
When a patient representative showed up to our ER bay to let me know that my “insurance was verified,” I pressed her to clarify what that meant. Would I be billed for this admission? She didn’t know. No one did: not the billing office, nurses, case manager, pediatric ER fellow, or attending physician.
All of them recommended that I call the number on the back of my insurance card for the definitive answer.
I’m livid that my insurance company was closed for the holiday weekend, and that it even closes at all. As the psychiatrist on call for my hospital, I worked the holiday, spending my daughter’s first Thanksgiving away from her and my family.
Working holidays, nights, and weekends is the cost of working in health care — a cost that many insurance companies are neglecting to pay. As I’ve written before, I’ve seen these irresponsible insurance practices impact my patients and now they were impacting my family.
This neglect should be illegal. In some states it is. Maryland, for example, mandates that insurance companies be available 24/7 to preauthorize care. Operating during limited business hours is bad practice. I didn’t know I had a bad insurance plan until I realized in those critical moments that I had let my baby down.
When she was stable enough, an EMS crew strapped my baby onto an oversized stretcher and loaded her onto an ambulance. I prayed that she would be all right en route to the next “in network” hospital. I hoped that it wasn’t a risk we took for no reason at all.
Update: After a week in the hospital, my daughter is recovered and back being her sweet and playful self.
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That’s my entire issue, why is it so easy for insurance companies to dictate everything in healthcare without any credentials whatsoever and a perfect 9-5 job….this is the systemic BS that has ruined healthcare. Force insurance employees through 10 years of school with according debt and then force them to work the same hours before they attempt to dictate what they themselves know nothing about and would never be able to do.
Since Jennifer doesn’t seem to comment here Kathy I wanted to reply to you. I am so sorry for your frustrations and anger and outrage. And I do know more than you can guess about life with terminal illness say cancer, ALS, heart conditions. All made more devastating by the insurance and medical systems.
If you were meant to refer to my not in the best interest of the child remark I am with you. It goes for every human being in here the great United States of America’s that trauma is inflected over and beyond the medical trauma. In fact the entire ancient concept of First Do No Harm has been thrown out of the window long ago by the current administrators and political supporters of insurance and hospital and ever other insect one finds when one is forced to lift up the swamp rock and deal with the medical systems underworld. It doesn’t have to be this way. There are good people but for some reason the concept of might for right has utterly disappeared in this country and world of ours.
I mean no offense, but during my husband’s “surprise” terminal illness of 6 months, I learned that medical personnel, to include also the hospital’s financial people, are about the last ones to ask about coverage. Always get it from the horse’s mouth and in writing, and even then be ready for the tortuous likely event of appealing the various denials. There are many “gotchas” in the fine print. I’m not sure if any of the current proposed fixes would be any better, but it’s difficult to imagine a worse mess than our system of accessing healthcare in this country. It is telling that even a medical professional ran into the insurance issues she describes in this article.
And to those who feel it was child endangerment to consider coverage before signing consent to treatment, I’m guessing you’ve never received invoices totaling thousands of dollars denied by your insurer because you accessed the wrong hospital, wrong department in a hospital, or the wrong provider in an otherwise in-network medical group. Or because the insurance doctors disagreed with the treatment or procedure advised or performed by your own. Bills of this size can bankrupt a family.
I’m glad your little girl is OK.
The dice are always loaded in the insurance company’s favor. They require that you call them “within 48 hours” of an unplanned hospital admission. Well, those are the admissions that are usually associated with an acute emergency,and often happen outside their “business hours.” So when I was unable to reach the company at 1am from the ER a few years ago, I expressed concern to the Admissions Office. They told me not to worry, that they would notify the insurance company which, of course, had no voicemail service, no online notification system — nothing but a requirement to call “during business hours.” Opioid pain meds didn’t make that a simple task. When I reached them to confirm that the hospital had called them, they denied any knowledge & told me I’d be penalized $200. Profiting off people’s illness is what it’s about.