Note: I asked my wife, Becca, if I could share this. One reason it's so hard to talk about this topic is that medical stories are so personal. But after reading Time's article I could see why these stories matter. They can validate our desire to change a bad system. Hopefully this story does the same.
Shortly after Becca got pregnant with our second child she began to worry.
It happened after her third prenatal visit, at around 12 weeks, when the midwife couldn't find a heartbeat. The baby was still small, maybe just too small to catch on doppler. Sure enough, an ultrasound showed that everything checked out—the baby was the right size, everything was normal (as normal as it is to grow a human inside a space that grows no bigger than a car battery).
Four weeks passed before her next prenatal visit. This time, still no heartbeat. The midwife was worried, but because the last ultrasound had checked out, she told Becca to come back in two weeks.
Before the two weeks were up, Becca saw blood. She rushed in for another ultrasound. This time, they gave her the worst sort of news: there was no heartbeat. The baby had died.
What happened next, aside from being one of the most heart-rending experiences of our married lives, was a tornado of medical decision-making. The midwife scheduled us that day to see a doctor we'd never met before, one who would (according to them) perform surgery to finish the miscarriage and remove the baby. We met with him and answered a slew of graphic questions, and saw the baby in ultrasound one more time. It was horrific stuff, and not the sort of experience I'd wish on anyone.
And of course, there was the whole matter of payment, which concerned us particularly since our insurance didn't include prenatal coverage.
So we decided to ask about the cost. We waited a full half hour in the doctor's office for the billing representative to call around and find some sort of ball-park estimate for our procedure. Left alone in the room as people chased each other down to give us a number, we wondered to each other: "Isn't this one of the few procedures they actually do at an OB? They don't know off the top of their head, even a ballpark of what this sort of thing costs?" And: "Has no one asked this before?"
Finally we got a number (about $600), scratched it out on a post-it, and went home.
But after we got home, after we had a minute to think about the whole miserable day, we decided we weren't comfortable with a doctor we knew so little about. So we called around and used some of Becca's dad's medical contacts to find a better referral.
Thus began round two of doctor visits, which was more of the same. Answering questions, scheduling our procedure. Becca was relieved to be with a doctor she trusted, but at the same time, since it was a new provider, we didn't know how much it would cost. So we asked the receptionist to give us another estimate.
And again, we waited.
It took so long that they sent us home and told us they'd have someone call us with the details. Hours after our doctor visit, a billing rep called us with a new number: $2,000-$5,000.
It turns out that the $600 figure was just the doctor's fee and didn't include the facility fee, hospital, anesthesiologist, etc.
We had already scheduled the procedure for the next morning at 8:00 am, but when we heard about the full cost we started to seriously second guess whether it was something we really wanted to do. $600 wasn't stressful, but $5,000 was. We eventually decided that we'd call the next morning and postpone the procedure, giving us more time to think about it.
However, Becca was up in pain before dawn, and thankfully the miscarriage occurred naturally at 7:50 am, just ten minutes before we were supposed to be at the hospital. We had avoided all the possible side effects that come with surgery, including possible bankruptcy (who knows whether $5,000 was really the upper limit).
And still, that pregnancy wasn't cheap. Between midwives, ultrasounds, and doctors, it cost us close to $900 to not have a baby.
And yet, I'm grateful that it was only $900. Reading Steven Brill's article from Time and learning about people who were hammered with bills in the tens of thousands further solidifies my gratitude. We had quality care and, as far as bills go, we didn't have it so bad.
But the questions we asked as we waited for estimates are still relevant. In his piece, the central questions Brill asks are "Why exactly are the bills so high?" and "Why does simple lab work done during a few days in a hospital cost more than a car?"
These are the questions that vex me. Every other market gives the customer the cost upfront and lets them compare the price with other sellers. Why does health care have to be a world unto itself on this front? Why does pricing have to be such a stressful issue on top of the emotional and physical stress that accompanies a visit to the hospital?
It doesn't have to be like this, and the article does a good job of illuminating why things are the way they are. It also illuminates who's in the business of driving up medical costs. There's a reason the doctors, nurses, and receptionists don't know what's on their bill sheets: they're not the ones pulling the strings, and they're not typically the ones getting multimillion-dollar paychecks in the industry. If you want to know the how and the why of exorbitant medical billing, look no further than Brill's article. It's certainly better than experiencing it firsthand.
Brill also does a good job explaining how things work in this Daily Show interview: