My $145,000 Surprise Medical Bill

What my brief glimpse into the financial abyss taught me about the American health care system.

By Jennifer Finney Boylan, Contributing Opinion Writer

Feb. 19, 2020 in The New York Times

“Well,” I said to my wife. “We’re wiped out.”

She’d called me late in the day to let me know she’d received a bill for our child’s hospital stay. The bill was for $145,000.

“What are we going to do?” she asked.

“I’m sure it’s just a mistake,” I said.

“But Jenny,” she said, “what if it’s not?”

The bill in question was for a procedure that had been scheduled months before. We’d consulted with the provider, who, indeed, was out of network, but our doctors had assured us that the total cost would nevertheless require nothing but a modest co-payment.

But in this our doctors appeared to be wrong. Now we were looking at a bill for $145,000.

I believe this is what people refer to as a “surprise medical bill.” About 20 percent of Americans receiving elective surgery are now on the receiving end of these bombshells. This month, I got one.

I went to bed that night not knowing whether we would have to declare bankruptcy in the morning.

In the House of Representatives, two bills have been proposed recently to address crises like the one now facing our family. The Ban Surprise Billing Act, sponsored by Lloyd Doggett, Democrat of Texas, would require hospitals to notify patients and get consent if they will be receiving any out-of-network treatment. And last week, the Ways and Means Committee sent the Consumer Protections Against Surprise Medical Bills Act to the House floor. This would also flag potential out-of-network costs for patients, and require insurers and providers to settle disputes through arbitration.

I have no idea how these bills will fare in the Republican-controlled Senate (and they have not yet even been passed by the full House), although I will note that the Senate is the same institution which devoted itself in 2017 to the noble dream of taking away health care coverage from 29 million people by repealing the Affordable Care Act. That effort failed by a single vote, of course — the last great political act of John McCain, who, although no fan of Obamacare, hated even more the idea of bullies picking on the little guy.

The bully in this instance being — well, you know.

The presidential election will give us a chance to end bullying of many different varieties. If Senator Elizabeth Warren winds up not becoming the nominee, it is possible that one reason for this was voter uncertainty about her “Medicare for all” proposal. Apparently whenever Americans consider this idea, we are thrown into a panic by the possibility that we will lose our health care insurance, and that it will be replaced by some governmental entity.

Such as Medicare, which people like, by a wide margin.

Ronald Reagan denounced Medicare, back in 1961, as socialized medicine. If Medicare wasn’t blocked, he said, “one of these days we are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free.” Before Medicare, only 54 percent of Americans 65 and over had hospital coverage; three years after its passage, 96 percent of older Americans did. Eighty percent to 90 percent of recipients really like Medicare — and these older Americans are the most conservative voters in the country.

Which makes you think.

I admit I have never quite understood the hatred Reagan had for Medicare, nor the hatred today’s Republicans have for Obamacare (itself modeled on Romneycare, a Republican idea). Is it just that they cannot abide the idea that government sometimes — even if only as a last resort — does good things?

I contacted our doctor the day after we got our $145,000 bill and he very kindly told me not to worry. “Doctor’s orders!” he added, which I thought was nice. Later, another doctor in the practice told me that even when procedures are pre-authorized (as my child’s was) insurers often deny them anyway. His understanding was that insurance companies often respond to preapproved claims with denial and delay, hoping that consumers will somehow just give up.

Fortunately for our family, my child’s doctors did not give up. The bill was fixed, and our family is not, as I feared, wiped out.It would be nice if the members of Congress — looking at you, Republican Senate — had this same devotion. It would be nice if they came to understand that there are worse things in the world than making people’s lives better.

Sometimes I fear American health care has contracted the capitalist equivalent of a condition called Cotard syndrome — the unshakable conviction that you are dead. One of my aunts suffered from it, in fact. “I’m dead,” she announced one day. “Don’t worry, it doesn’t hurt.”

The cure for my aunt was antidepressants; the cure for American health care is the kind of universal coverage that virtually every other civilized nation has. Have our health care insurers really been so angelic to us that we cannot possibly imagine something better?

We hate our insurance companies. We hate them more than lima beans. We hate them more than spin class. We hate them more than colonoscopies. We hate them more than jellyfish.

And yet somehow, the prospect of losing them is the thing that fills us with terror.

It would be nice just once if our insurance companies were filled with terror by the prospect of losing us.