She Was Angry About Her Emergency Room Bill. But Should She Be?
"White Coat" blogged at KevinMD about the story of a woman whose toddler hit her head on a metal patio table. Blood...panicked daddy...mommy a "trembling mess" on the inside.
Not wanting to wait two and a half hours at urgent care, mommy and daddy headed off to the emergency department at the hospital. As White Coat puts it:
They were evaluated immediately by an emergency nurse and then 10 minutes later by an emergency physician. The emergency physician evaluated the child, determined that putting stitches into the laceration on the child's lip would be more traumatizing than letting the laceration close on its own, and then gave the child a popsicle.Wait? That's it?
The bill? $514. Cue irate mom: Here's her article in the Bangor Daily News, complaining that this amounted to "one pricey popsicle."
Um, not quite.
But "White Coat" puts it well:
I absolutely agree that $500 is a lot of money. And based on Ms. Fuelner's perceptions, some people may think that she got "ripped off" for the services she received. Unfortunately, in the world of $20 copays and government-mandated free birth control pills, there seems to be a pervasive belief that medical care should cost less than an appointment at a hairstylist and should definitely cost less than the newest iPhone.Let's look at what Ms. Fuelner got for her $500.
She got the convenience of immediate access to a large business providing services to the public that is open every minute of every day. That business has millions of dollars of overhead costs every year that it must pay just so that it can keep its doors open. She got immediate access to expertise from a nurse who spent tens of thousands of dollars to go through years of post-graduate training and who gave up her weekend so that she could be there to care for sick and injured patients.
She also got immediate access to a physician who spent hundreds of thousands of dollars and went through even more post-graduate training, and who also gave up his weekend so that he could be there to help sick and injured patients. Those are just the two medical professionals who cared for her child. I'm sure there were many more available in the department. I could go on and on about all of the hard-working personnel in the hospital whose services are available and who contribute behind the scenes to many patient visits -- radiology, lab, surgical personnel, registration clerks, billing department, housekeeping, maintenance, cafeteria, security, IT, and many others -- even administration, but hopefully you get the point.
The hospital also has advanced diagnostic equipment costing millions of dollars -- available and waiting if Ms. Fuelner's child happened to have hit her head and had brain bleeding, knocked a tooth out and inhaled it into her lung, suffered a neck injury, had eye trauma, or suffered some other injury from her fall. Fortunately, that wasn't the case.
Federal law also requires that the hospital provide a screening exam and stabilizing treatment to any patient who is seeking medical care -- regardless of the ability to pay. I'm sure that some of Ms. Fuelner's $500 went to defray the costs of many others who receive care but who either cannot afford to pay or whose insurance pays for less than the cost of care.
Most of all, Ms. Fuelner and her husband received peace of mind for her $500. Her daughter was evaluated by a medical professional who considered all of the possible injuries and determined that she had not suffered any serious injuries. When patients tell me that they feel embarrassed for coming to the hospital, I stop them mid-sentence. Don't. It is always better to be safe than sorry. Consider what would have happened if you had not sought out medical care. You would have been up all night worrying and searching the internet on Dr. Google trying to figure out about what to do for a laceration on a child's lip, then you probably still would have sought out medical care the next day.
So, no Ms. Fuelner, you didn't pay $500 for an emergency popsicle. The $500 you paid went to help cover some of the immense costs involved in being able to provide quality medical care to you and your family at any hour of any day and it went to the peace of mind that you and your husband experienced when the doctor examined your child and told you that everything would be OK.
The popsicle: That was free.
And just an aside: Sorry, because KevinMD has some good articles, but that name -- well, it sounds like a gay escort who comes to your door with a butt plug hanging from his stethoscope.
"it sounds like a gay escort who comes to your door with a butt plug hanging from his stethoscope."
Thanks for that image that is permanetly seared into my brain.
HungryMoose at October 3, 2015 11:46 PM
Mr. & Ms. Histrionic Helocopter Parents' baby got a boo-boo and needed a bandaid. They discovered that their "free" ObamaCare has a high deductible for the misuse of emergency medical facilities and care. Boo F*cking Hoo.
In the bad old days before any cut or bruise required a drama trauma response (or risks a call to child protective services triggering a neglect investigation), the response would have been put ice wrapped in a wash cloth on the cut till it stopped bleeding, gently wash it and put an OTC antibiotic ointment and bandaid on the cut, change the bloodied shirt, give the kid hugs and kisses throughout this process, give the kid a cold drink, ice cream or popcicle, and finish with "Let's go back outside and play." It's unlikely the accident would be remembered next week, much less recounted in a breathless blog. But, in the bad old days, one didn't have social media to proclaim to the world in a permanent record how (self) important I am in my victimhood. Rather, time was spend on unimportant matters such as family activities.
Wfjag at October 4, 2015 12:22 AM
Parents don't know anything about this any more.
When a "family" is "a group of people", or a single mother, the collective experiences and coping methods are lost, and there is no class on this sort of thing at school. It would show pictures of blood! The horror!
Radwaste at October 4, 2015 6:59 AM
She should call out a plumber for a burst pipe on the weekend and see what his bill comes to.
llater,
llamas
llamas at October 4, 2015 8:34 AM
Where in America were they able to get in and out of an emergency room for only $514?
Ken R at October 4, 2015 10:36 AM
They're the most important thing in the world... until parents have to shell out their own money for them. (And I note that most of the $514 was picked up by insurance. She's still bitching.)
Anyway, I've gotta go get a butt plug out of a "patient." Later!
Kevin at October 4, 2015 2:32 PM
Hell, I want the insurance and care that she got for just 500 bucks!
That's a bargain!
charles at October 4, 2015 5:32 PM
There is a fly in the ointment: "( Some of Ms. Fuelner's $500 went to pay the costs of many others who receive care but who either cannot afford to pay or whose insurance pays for less than the cost of care. )"
I don't blame White Coat much. He is embedded in a system distorted by our government.
Compare this to your auto shop's bill. You don't see "$35 oil change, $15 changing other people's oil", because you would switch to a garage which charged you only for the work done for you. Charging for work not done for you is illegal; it is fraud.
Our caring Congress requires by law that hospital emergency departments accept and treat anyone regardless of ability to pay, and to the same extent as a paying customer. That's nice. Where does the money (resources) come from to do this? Hospitals, doctors, and nurses don't devote their lives to charity. They too need to eat. Our caring Congress neglects to fund this mandate.
Hospitals and doctors have raised their fees and bill the insurance companies of their patients who have insurance or have enough assets to pay. Hospitals have raised their fees A LOT to cover all of the charity work required by law. This is perverse, billing one group of sick people to pay for another group. But, all hospitals must do this. The sick who can pay are a captive group. This creataes the $20 hospital aspirin.
Insurance companies do not cooperate entirely in being charged for charity. They have raised their fees for health insurance coverage, and they negotiate with hospitals to pay only a set fraction of hospital charges. This complex interaction of negotiation and artificial fees results in enough to pay the insurance companies, along with greater denial of care, and the failure of many emergency departments.
Interesting, that Mrs. Fuelner paid $514. They probably had insurance, and that was their co-pay of $500 plus a few minor charges. The bill to the insurance company was probably much larger, of which the insurance company paid a fraction. The insurance company has set its rates higher to cover things like this, high enough to pay for Mrs. Fuelner's daughter plus other non-payers.
Pity the person who has an uninsured heart attack. The bill will be $300,000. The insurance company of an insured patient would probably pay around $30,000. The hospital charges $300,000 because sometimes it can get it, or at least more than $30,000. The insurance company demands that the list price be collected if possible, because it wants to sell insurance against these "catastrophic" charges.
It is a confused, rotten system imposed by stingy, uncaring politicians. Politicians have convinced the public that they are providing free emergency care by decree. The consequences are complex, expensive, and not well understood.
In short, the government has imposed a health care tax on all sick people, paid by those with resources or insurance. It is a wonderful tax on the middle class, hidden in a maze of intermediaries and hospital bills impossible to understand.
Andrew_M_Garland at October 4, 2015 6:26 PM
And again, here's the answer.
Radwaste at October 4, 2015 9:13 PM
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