In April, Noah (22 months) fell on the playground. It wasn’t an especially bad fall, but he bumped his head pretty hard. He cried, but mostly because he dropped the ball he was carrying– he quickly stopped when it was returned to him. No big deal. He had a nasty bruise and some swelling, but he’s had worse.
Later that night, he threw up after dinner. This was worrisome, since he’s had a pretty strong stomach and has only ever done so a few times in two years. Googling around, the general consensus is you only need to call the doctor after the third instance of vomiting when no other symptoms are present. Whew!
Until he threw up three more times over the next hour.
So, Jane called the nurse’s line and they suggested we go to Dell Children’s Hospital, the best in Austin. We piled in the car and headed over, convinced that we were probably worried about nothing, but still… He threw up in the lobby and we got into see a nurse a few minutes later. She offered an anti-nausea pill (“Zofran”) which we initially declined but went back to get after he threw up yet again. After more waiting, we got in to see a doctor, who probed at his bruise/bump a bit, reiterated his medical history, and had us give Noah some more water to see if he could keep it down. Eventually, he decided that we should do a CAT Scan just to be sure, and we all headed downstairs for the scan. Throughout the process, Noah was happy and wide awake, apparently excited about getting to hang out past his bedtime in a neat new place with lots of gadgets. We assumed this would end when he had to lay down for the CAT Scan machine, but he was the perfect patient, laying down as quietly as he ever had and not moving at all for the scan.
An hour or so later, we got back the results (no problems found, yay!) and we got discharged with a diagnosis of “mild concussion” and a prescription for more of the Zofran just in case he needed it.
A few hours after we got home, I apparently “caught Noah’s concussion” and began throwing up. Oops. Well, at least we ruled out any kind of real problem; there was no fever, just some nausea and difficulty in keeping food down.
We both got better within a few days.
Then we got the bill. The letter the hospital was pretty simple: “Hey, send us $2150. Got any questions? Talk to your insurance company.”
A few days later, the insurance company sent over their explanation of benefits, explaining that they’d covered $2017, we got a $1041 discount, and we owed the remainder of our annual deductible ($2150). They at least offered a slight breakdown of the charges:
Even still, we wondered about the $309 “Pharmacy” charge—Noah had only taken two tiny pills (dissolved) and they seem to have a street price of $2 to $12, depending on where you buy them. What’s up with that?
The lack of detail here made it seem almost as if the insurance company had no interest in preventing fraudulent billing. Weird.
Jane called and nagged the hospital into sending over a detailed bill. That they didn’t send it on the back of the initial letter irritates me to no end, but it immediately becomes clear why they might not want you to know what you were charged:
The Zofran was marked up at least 1000%. The “5GM Cream” was some sort of topical anesthetic that the nurses had applied to his hand just in case he needed an IV if he didn’t keep down the water he drank—my guess it had at least the same level of markup.
Fortunately, my employer provides ridiculously good healthcare benefits (they even pay deductibles!) so the entire trip didn’t directly cost us anything. But I’m terrified of how broken the pricing model is for healthcare is in this country. I’m a big fan of the ACA, but if we as a country don’t find a way to rein in uncontrolled healthcare costs, we’re doomed anyway.
Time Magazine did an awesome story on this topic almost exactly two years ago: http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/