231 BPM
Image from Unsplash
Prologue:
A couple years ago my wife fell in an airport. An ambulance was called and she was tended to by an ER in Dallas. Unfortunately, nobody called to make sure that the ambulance or the ER was in-network1 and we were on the hook for around $10,000.
The Story:
On Friday the 28th, I arrived at my parents house and got on the sofa to relax and watch some football. After a bit I started feeling really tense in the muscles in a way that is strange for me. I remember that coming first because I thought that I needed to ask my wife for a massage when she got there and that’s something I almost never need (that she frequently offers because she needs them and I give them). After that, though, I started feeling pain in my chest. That pain just kept getting worse. I was having a heart incident (not an attack, though) and it ultimately landed me in the ER and for three days in the ICU. I feel better now.
As this was happening on that Saturday afternoon, I was remembering the airport. I was also thinking about we had already hit our out-of-pocket maximum of $13,800. I really, really did not want to get hit with tens of thousands of dollars of medical bills. So I got on the app on my phone to find an ER that was in network. Except that the app wasn’t working. As this was happening, the intensity of the pounding in my heard kept increasing. Then next thing I did was grab a laptop to log in there. However, when I put in the password I got a message telling me that my password had expired and needed to be changed. The changing of a password is actually a complicated ordeal involving verification emails that end up delayed or in spam folders because Google and Microsoft consider them suspect. It can take five or six before one gets through.
I didn’t have time for that. that was the end of it for me. Not just in the sense of my quest to avoid needlessly spending five figures, but mentally and emotionally I just broke down. Even if I thought my did I think my wife was prepared to knock me over the head to drag me to the nearest ER. As it was, I just broke down and did what she told me to do and sat there and thought about how we were going to pay for this. We actually ended up at a deceptively titled urgent care clinic, where my care was delayed by the fact that they required you to use a smartphone to check in. After ten minutes of failure with that they let her use a pencil and paper.
By the time they got to me, my heart rate was so high that it was above their equipment’s ability to give an accurate estimate. They said “somewhere between 200 and 240 beats per minute”. They were absolutely not equipped to take care of me so either they would call an ambulance or I would sign a bunch of paperwork telling them that I had declined that offer so that I wouldn’t sue them. I wanted Clancy to drive me2 to *at least* avoid that expense but she flat out refused explaining that she wouldn’t be able to forgive herself. She was already feeling bad for having indulging me as much as she had, when apparently my situation was far more severe than I had signalled.
In the ER, my heart rate peaked at 231. I was cold, clammy, sweaty. I wasn’t dying, but much further delay would have threatened permanent damage. And there were concerns about blood clots. It took about a half-hour to get my heart rate below 170, which was cause for celebration. More intervention and it stuck at about 140, which is my intense exercise heartrate except that I was literally just laying there. They were having to put so much in the way of “calm the heart down” drugs that they were making my blood pressure itself perilously low.
I was in the ICU for about three days while they tried various things to get my heartrate under control. One the second day they put a scope down my throat and zapped my heart, which was pretty successful (which is good because if that hadn’t worked they would have put the scope back down my throat and “fried” it, was the word that they used) but then I failed the stress test so they had to do a heart catheter. The heart cath turned out fine, though, so they let me go on the fourth day.
A day later I drove to Central Texas where, by the way, my second daughter was born very early on Halloween morning. That’s a story for another time.
The Angle:
There are a number of ways to approach this story. A testimonial of a heart scare. Missing the birth of my daughter while I was in a hospital across the state. But what really jumps out at me is how much time and energy I was spending with an out of control heart trying to verify which ER I could go to that wouldn’t risk financially breaking us. This is not a very realistic burden to put on people. It’s not a humane one.
Some will point to this and say “Single payer will fix this!” and they’re not wrong. Whatever problems may occur from single payer, it would fix this. The thing is, though, that there are other ways to fix this. Multiple other ways. I think the arguments for in-network and out-of-network with negotiated rates (versus consistent pricing) are weak at the start but however we manage that we need to find a way to do so that do not involve people risking heart failure trying to log onto a website to find out whether their hospital visit will cost $0 or upwards of $40,000. Any conceivable advantage to negotiating rates or giving patients “skin in the game” really doesn’t justify this sort of thing (at least when it comes to ER activity).
As it turns out, it looks like {fingers crossed} the hospital was in-network. My parents and brother both also said that the family would have taken care of me had it come down to it. So, in multiple ways, this isn’t about what would have happened to me personally if I’d incurred a giant medical bill. We wouldn’t have faced financial ruin in any event. It is, however, another reminded that whether you believe in single payer or market medicine, our system is not a defensible one.
For all the ink spilled over who pays for healthcare the fundamental issues with the system are far less private versus public and far more about the arbitrary and unpredictable gaps.Report
A private system is going to be more likely to have these arbitrary and unpredictable gaps. The only way to really prevent them is by the government doing a slap down of some sort and telling them to get it out.Report
You’re absolutely wrong. About half my clients are in the UK, Canada, and Europe, and they have an equally frustrating (if not more so), albeit slightly different, set of frustrations and concerns with their health care than we do in America. People in single payer countries have just as many issues with poor care and delays of treatment, it just comes in a different package than it does here in the US.Report
So what’s your proposed solution?Report
I believe this with zero difficulty, it seems so intuitively obvious as to be inevitable. A switch to single payer is exchanging one set of headaches, frustrations, failures, and stresses for a different set of headaches, frustrations, failures, and stresses. As would any other system someone might care to proffer.
The question is whether one system offers marginally less headaches, frustrations, failures, and stresses. And picking between two bad systems to identify which is less bad is not something people generally do very well.Report
More transparency (and therefore more predictability) would be nice but we’re in a place where knowing that the close hospital is the expensive one and the cheap one is across town is going to leave us with the same problem.Report
To me it’s more an issue of the whole ‘in-network’ considerstion. If you’re insured the lack of pre-emptive haggling between the payer and the provider on what they pay for a procedure shouldn’t fall on the individual.Report
What a crazy week for you! I am so glad you are ok!Report
I’ll second that.Report
I’ll third. Glad you are Ok.Report
And he didn’t even mention that the Ordinary Times web site had a meltdown while he was traveling. Which he fixed.Report
Dude’s my hero.Report
What a total giant!Report
He needs to make his Amazon wishlist public.Report
I actually just got the bill for re-upping with our host. So I’m probably going to throw up a fully loaded fundraiser.Report
I’d contribute.Report
YepReport
the whole log-in to apps to do anything is evil when it’s something this urgent. There has to be a way to do it better. I usually wind up cursing out the on-campus apps for things like requesting my textbooks for next semester and the like (seriously they expect me to *remember* a unique password with at least eight characters and an upper case letter, a lower case letter, a number, and a “special character” when I only use the app once every four months?)
But in this case, yeah: could be a case of life or death. I’m glad you’re OK but I think every medical provider involved needs to feel shame about how much they delayed someone getting treatment because of stupid apps.
Oh, and congratulations on the new baby!Report
Or less importantly, but very irritating, every dinkwad tourist town has their own parking app to DL when you just want to get lunch and walk around for an hour. Sorry, need to DL Blark!Report
As I’ve said for decades now, “To err is human; to really screw things up requires software.”Report
Most apps accepting Biological passwords has been a big help.
However, I’ve been burned by apps (usually Travel after the long Covid Hiatus) that don’t get used all the time then they update and pretend that their security protocols can’t possibly transfer your old biologic password until you log-in manually and re-set your bio password. Usually this happens with a line behind you.
Basically, for an app you rarely use, like healthcare app… the bio-password is reset so often as not to provide the longterm value of having a bio-password.Report
Do you mean like fingerprints? My new laptop has a fingerprint sensor to log in and at least half the time I have to default to the (mercifully: short, numeric, easily-remembered-by-me PIN) because “We don’t recognize your fingerprint, try another finger”
(“Fool, I am using the finger I set up the sensor with!”)Report
Heard a horror story about one of the local military bases. They had retinal scanners. As it turns out, the veins in the back of your eye change under a handful of circumstances and one of those circumstances is somewhat common: Pregnancy. Like, even *EARLY* pregnancy when one might only be vaguely suspicious that something was going on.
This means that there were a handful of women caught in the man-trap trying to go to work and not being able to get through… and everybody in the security office knew exactly what was up whenever Staff Sergeant Whomever didn’t get through the gate.
Well, it happened to a Colonel. They got rid of the scanners.Report
Given that all contemporary phones and laptop computers come with built-in cameras, I’m surprised they haven’t figured out a way to use iris recognition.Report
Glad you are fine. At least you’ll be able to get plenty of rest, well when the baby is chill.
This kind of issue was always there and noted by health reformer types. Emer health is not meant to be a consumer product. Most important health care works really badly as a consumer product.
“Skin in the game”. Allow me to nuke that phrase from orbit. You got skin, you’re in the game. Money, payment??? F that. You’re health and life means you have all the possible skin possible regardless of the payment deal.Report
First thing – hugest congrats and I’m so thankful you’re ok.
Was it A-fib or SVT?? Did they say? Either way, don’t fear the “fry”, my dad (for a-fib) and a close friend of my husband’s (for SVT) had it done and it was a godsend for them. Very easy procedure and 100% fixed.
Aside from my concern for your health and wellbeing, on a personal level, it is moderately bizarre to read the medical reaction to your story. I have SVT and my heart was regularly going over 200 BPM. This happened for years. I spent huge amounts of money on doctors and tests, but no one believed me that it was happening. They could never see it happen on their machines, and when I tried to describe my symptoms they brushed me off. “Young women don’t have heart problems, anxiety, too much coffee,” etc etc etc. When I finally did capture the 200+ beats on the heart monitor a decade after attempting to get treatment, they didn’t call an ambulance, didn’t have me rush to the hospital, none of it. No concern about blood clots whatsoever. I wasn’t even offered medication until five later, and I had to fight for that (with another massive expense and months of time on testing beforehand). One pill a day has all but cured me. It was life changing, and I think back on 15 years of heart skipping, dizziness, SVT events, years of my youth wasted as an invalid terrified I’d die at any moment and everyone around me treating me like a hypochondriac for a problem that was absolutely real, and it makes me sick. My doctors still to this day don’t believe that I was having heart-related chest pains, even though the chest pains immediately resolved with medication. I just do not understand why some people are treated with alacrity and others just get a shrug. I would call it sexism but I’ve seen it happen to a lot of men, too.
The reason I bring all that up is that this was all done in-network, with plenty of time to arrange appointments with the proper doctors. While I agree the “out of network” crap is appalling and absolutely evil, the truth is that even in-network treatment isn’t cheap or fast, and patients must fight tooth and nail for basic care and experience delays that are oftentimes fatal. My mother in law, who had excellent insurance at all in-network facilities, died in January from a treatable case of diverticulitis after having been put off by her doctor who told her she just had a UTI. Her insurance covered everything, we didn’t even have to pay a co-pay, but what good was it? The paid-for doctor still caused delays in treatment that cost her her life.
In vs. out of network is just the tip of a massive iceberg. Medicine needs reform badly and unless that happens FIRST, single payer would simply congeal all these pathologies into a system that would then be basically above reform.Report
One of my daughters had SVT diagnosed as a kid; had the “burn” at 13 and gets checked annually to see if it’s back. Its definitely a good treatment.
As to your case Kristin – what you are describing is almost classic sexism in medical care. this is a well documented problem that exists independent of payer. And its a problem that needs to be squashed sooner rather then later.Report
AFIB. There was also a heart murmur
The overarching issue is the unpredictability of expenses. Both “Will they pay for the procedure that was done” and “Will they pay the particular provider that did it” are manifestations of this issue, both feeding into “How much will it cost if they don’t?”
I’ve spoken up on the former before – mostly on Twitter – but in general I find it a harder shell to crack. Every solution is seems either vague and straightforward that it’s hard to really oppose (like “make pre-authorization more efficient!”), or clean and simple and easy but not workable (“If a doctor says it’s necessary then insurance should pay for it end of story!”)
The network stuff, though, has multiple solutions compatible with many different health care models.
As far as my treatment goes, I would guess it has a lot to do with the fact that I rolled up there with acute and undeniable symptoms. It wasn’t just that my BMI got that high but that it wouldn’t go below 190 (at first). With all that, dismissing me the way you were dismissed would have opened them up to lawsuits. My impression of the urgent care clinic in particular is that they were 100% in avoiding lawsuit mode. Clancy said the only unusual part of my care was that I was put in the ICU and kept there when in most hospitals there would have been some sort of middle tier of care and they would have moved me to the main floor sooner (I think the main reason I wasn’t was inertia.)
FWIW, I would bet on sexism as being a factor for the treatment you got. It seems to be a huge issue with chronic illness in particular, which is harder than acute incidents like mine at baseline but also probably susceptible to all sorts of conscious and subconscious stereotypes. I’m really sorry you had to go through that.Report
For 100 in Biological Beats:
231 BPM
“What would be my BPM if Lady Marchmaine told me we were expecting our 7th, Alex”
Glad you’re feeling better, and I’m sure you young folk can easily handle your new little baby… congrats.Report
Will I’m immensely happy to hear you came out of that okay and that Daughter #2 is healthy and with her whole family. Including her dad.Report
I don’t think single-payer would necessarily fix this. All healthcare systems have some boundaries surrounding what it considers to be essential medical care, and those that are adjacent (mental health, midwifery, and nursing care come to mind). I’m skeptical that even if the U.S. became a single-payer system that “transport” would suddenly come within essential medical care (it’s currently not at the national level). It could, but a reason it wouldn’t is that it would reduce the cost of transition.
Oh yeah, good to hear you survived the U.S. healthcare system.Report
it’s not really about ambulances specifically.
The thing that single payer would address would be the degree of price opacity, uncertainty, and inconsistency that comes with networks (and providers so commonly paid by insurance that they can’t cite a price). That is a feature of our specific system.
In the case of ambulances in particular I think if it’s not covered it becomes a city-county service with consistent (albeit not inexpensive) pricing and that could be factored in instead of “Maybe the trip to the hospital will be free or maybe it will cost more than surgery.” — but again this isn’t really about ambulances.
(I’m not saying there would be no variation – though regulation could do a lot there – but we’ve been on Medicaid and we’ve paid cash and we’ve been on insurance and the third is qualitatively different than the other two.
Single Payer would either pay for it or if not normalize pricing. A straight cash/market system would do the same with a modest amount of regulation.Report
If I recall the Swiss system correctly — and it’s been years so they may have changed it — the care providers as a group negotiate rates with the insurance companies as a group. The government resolves things the two groups can’t reach agreement about. In-network vs out-of-network is not something health care clients have to worry about.Report
I’m kind of tuned into ambulance policy now. Where I live two emergency workers were charged with first degree murder for how they strapped the patient to a gurney. It seems like they were burnt-out and disgruntled about having to work another weekend night shift, and a lot of people are blaming the profit-motive of private ambulance services for staff shortages. But it turns out that it would be prohibitively expensive for the city to operate such a service without imposing similar cost controls that are blamed for the murder. It looks like we are moving towards having fire fighters who are trained as EMTs or paramedics riding inside when they are on the scene and there is a need.
From what I’ve read, transport is simply treated different and there is no particular reason to believe a new system would necessarily include it. In Canada, ambulance services are provided by province health care plans, but are generally not portable outside one’s home province/ territory.Report
Fire/EMT is exactly what I had in mind when I talked about it being run by cities/counties. Generally in Texas, if you just want to fight fires you become a volunteer fireman and if you want to be a professional firefighter you become an EMT.Report
Our town has some kind of weird beef between administrators that has resulted in the fire department being the first ones who will be dispatched to a 911 call, but they aren’t permitted to render medical assistance beyond immediate trauma response, so they have to call the ambulance service as a separate dispatch…Report
Our town of around 8500 sends everyone. The police and Fire Department are often arriving together – the county ambulance contractor arrives later. Most of our trucks have an EMT or EMT Advanced. I think there is also a single paramedic per shift. But the town has zero transport capability so BLS or ALS you go by contract ambulance.Report
I have no problem untangling the network limitation. We lost all of our primary care and specialist doctors a couple of years ago because our insurer (Blue Cross/Blue Shield) determined that the costs at the largest physician group in the area were too high and they couldn’t read an agreement. The local hospital systems weren’t capable of meeting the new demand, but we slowly established new physician relations for the four of us. I think the physician group had a nicer set-up and was qualitatively different, but I now suspect that I was fed to a specialist for biannual check-ups that could have been performed by my GP. I wish I had the option of not changing and paying more out-of-pocket. In Canada, they apparently have private insurance for additional medical services that take place in another province. I wonder how much that would cost in the U.S.?Report
Note…to…self…: “Offering…to…contribute…to…cup…of…coffee…fund…for…Dev…Cat…counter-productive…in…some…circumstances…”
(Glad you’re recovering and congratulations on being a father again!)Report