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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. 

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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.

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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.

  • A baby is in desperate need of ICU care, and her Mom ‘prays’ that she’ll survive transport to cheaper health care. Wow. I’m not a hater, but she posted her opinion so I think it’s OK for me to express mine: I think this ought to be investigated as endangerment.

  • Our insurance system is a disaster and Aetna is the worst. My husband needs emergency back surgery because he’s in extreme pain and can’t walk. His x-rays and MRI clearly show the issue and he has already had 2 epidurals this year for the pain. Obviously, surgery was his last choice. His well respected surgeon scheduled the surgery immediately because of the pain my husband is in and the Aetna Medical Director denied the service. He said its “protocol” that he go to Physical Therapy and get a note from a PT stating he can’t do therapy. Totally ridiculous because the pain specialist told him not to do PT and he can’t even walk. Its clear that he needs surgery and PT won’t help his condition. Aetna is just delaying this process and causing major distress. Its unbelievable to me that an insurance provider can treat their clients so terribly. Our healthcare system needs to change.

    • Yes, with M4A everyone will have the SAME insurance policy acceptable at all hospitals and people could worry about the medical situation not the bills that can wreck their finances. Nothing is free – we pay through our taxes – but that is SO MUCH BETTER than this is.

    • @Spring Texan

      The problem with taxpayer-funded services is that they are cheap but not good, like the food, transportation, housing, clothing, and medical care provided in Communist countries.
      @ francisco J Cervantes
      It is a fantasy that Cuban medical care is anything close to acceptable.
      ———–

      When taxpayers fund services, economy and government inefficiency and waste keep the payments stingy.
      The public bus costs only a dime, but it doesn’t run often and it doesn’t go near your home or workplace — just up and down one main route.
      Food is cheap, but it is only cabbage, potatoes, and sometimes a sausage.
      Clothing is cheap, but it consists of one navy blue “iron” suit.
      Housing is cheap, but it is a few square yards per person in an apartment shared by 3 families.

      Here’s a .org article about health care in Cuba
      https://mises.org/power-market/dont-trust-cuban-health-care-statistics
      Here’s a National Review article
      https://www.nationalreview.com/2007/07/myth-cuban-health-care/
      Another .org article
      https://fee.org/articles/the-myth-of-cubas-glorious-health-care-system/
      from Al Jazeera
      https://www.aljazeera.com/indepth/features/2012/06/201265115527622647.html
      This pro-Communist puff piece admits
      ” … they do this without access to the latest in diagnostic technology or have to wait weeks for basic equipment to arrive at hospitals to perform procedures, even at times without electricity or running water.”
      ” … queues at hospitals and clinics are longer, and so are waiting times. Doctors have more work to cover in a stressful profession with limited resources. A patient may end up travelling to another province to visit a specialist … ”
      “Crumbling infrastructure
      The healthcare infrastructure in Cuba also requires serious attention. Some of the clinics and hospitals in operation are in dire need of repairs. So too is the urgent need of more modern medical equipment and stable electricity and water.”
      http://theconversation.com/is-the-cuban-healthcare-system-really-as-great-as-people-claim-69526

      In Communist China, you don’t get a doctor at all.
      You get a “barefoot doctor” — ” … farmers, folk healers, rural healthcare providers, and recent middle or secondary school graduates who received minimal basic medical and paramedical training …”
      And of course China persists in offering “traditional” Chinese superstitions in place of science-based health concepts.
      ———

      It is notable that when cost is not a consideration, international millionaires come to the US for health care, not Cuba.
      The Mass General even has a special wing whose hospital rooms are all fancied up with elegant furniture, baskets of flowers, rich fabrics … to please its wealthy international patients.

      If we want to, we could let the US fall victim to a taxpayer-funded health care system, but its quality would decrease and R&D would collapse.
      It would be cheap for individuals, however.
      But not all individuals. In the UK and Canada, people of means simply opt out of the National Health and buy regular insurance for first-class health care.

      Be careful what you wish for.

    • Actually we won’t have any care. The figures/facts bear it out. I have friends from Europe. India actually has no insurance (like the USA) but they have a better system. Try Dr. Devi Shetty and Naryana Hrudalaya.

  • I wonder what the response would have been if FLOTUS remained at a distance to study the opioid crisis? Would someone say “Why doesn’t she bother to come see for herself?”

  • Perhaps lawmakers could add a section to surprise medical bill legislation stating that if an insurer coverage hotline is closed when a patient or provider calls to ask about coverage, the insurer is required to cover the care whether in-network or not. My guess is that would result in a miraculous expansion of hours those lines are open.

    • Agreed. I wish the OP would have said what she had done to pressure the state legislature she’s in, and to encourage calling others. She has a valid complaint, but the way to fix the problem is getting lawmakers to do something about it in favor of the people and not insurance corporations.

  • Thank you Jennifer. As you must know as a psychiatrist your child was not only sick but also picking up on your own anxiety. As Gabe Mate has spoken of his birth during the early events of WWII and his constant crying, his mother’s pediatrician ssid all my Jewish babies are crying. So not only were you unduly distressed your child was as well. When taken to logical conclusions this is a form of Child Neglect in that it is NOT in the best interest of the child. We as a family have dealt with this from the early 1990’s onward. It does not have to be this way.

  • Great piece and policy idea for requirement. While with family over thanksgiving we too had to go to hospital late Friday night in rural area we were staying. Knowing the hospital system is where Americans rack up bills, I tried to understand what my insurer would cover. To no avail – they were closed.

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