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The $500 Emergency Popsicle

Popsicles

Image by Will Luo https://www.flickr.com/photos/analogian/

Natalie Fuelner created a well-written article in the Bangor Daily News describing some of the tribulations many new parents go through with young children. One weekend, her toddler fell face first onto a metal patio table. Immediately, the toddler’s face is full of blood. The dad panicked. Natalie was a “trembling mess” on the inside.
Their physician neighbor wasn’t available to look at the child. They didn’t want to wait two and a half hours at the urgent care center. They were both still panicking, so they went to the emergency department where 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, then gave the child a popsicle.
Wait? That’s it?
Suddenly their panic was gone. Then they felt embarrassment.
A couple of weeks later they received a $514 bill for the services and Ms. Fuelner quipped “That was one pricey popsicle.”

One innuendo from the article seems to be along the lines of a comic I once saw from Bob Vojtko. An elderly woman was pointing her finger at a doctor saying “I spent $4 in cab fare to get here, so you better find something wrong with me.” Another underlying theme in the article is that many people don’t realize the costs of providing medical care in this country.

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. See a prior article on this topic from Birdstrike here. As many communities are finding, the less you pay for medical care, the less medical care you have available. A few examples are here, here, here, and here, but an internet search will undoubtedly reveal many more articles about hospitals or departments that have closed because of insufficient funding.

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.

15 comments

  1. You forgot to mention that the knowledge and experience of the physician saved their kid from radiation exposure, medication adverse effects and a painful procedure with potential complications. Had they seen a PA or NP, the bill would’ve been a lot higher and the outcome (hopefully) the same.

    • If the PAs or NPs who work for you would’ve done differently, then you should do your job and train them better. From this articles description I certainly wouldn’t have scanned the kid unless he was altered, or he had sustained LOC, persistent vomiting, global HA, or under the age of 2 had a scalp hematoma….the same criteria that an ED physician would use. Nor would I have sutured an internal mouth wound unless it was a through & through….the same criteria that an ED physician would use.

      Hope you’re a better team player in the department.

      • But if you go to a 24-hour doc-in-a-box staffed solely with nurses or PAs, not a real doctor in sight, you often DO get sent straight to the ER for anything they deem too “challenging”. So you would have the $85 doc-in-a-box fee, PLUS the $500 popsicle, to deal with.

      • My job is not to train PAs.

        • Okay, then operate in your own little bubble and be passed by forward thinking EPs (and other physicians) as they reap the financial reward of having PAs work for them. Meanwhile, I (and tens of thousands of other PAs) will continue practicing medicine.

  2. We had a similar story…but the doc in the ER just sent us home…no charge. Said it wasn’t worth the aggravation for all of us…ice, tylenol, and a little spoiling…K4 was good as new in 2 days. Sometimes you get lucky..that was 12 years ago…

  3. Or for $200 they could have just settled for having a report made to Child Protection Services for a neglect/abuse evaluation, for letting their child play near dangerous metal equipment unsupervised, without a protective helmet, not being wrapped in foam, and without an EPA-approved safety survey and clearance of the play area by a Secret Service-trained team of agents, including some trained in battlefield trauma.
    For $50 they could have asked the kid up the street who used to be on ski patrol once, ten years ago, to have a look.
    And for $5 they could have just hired a witch doctor from Trashcanistan to rub dog crap and bat guano into the lac, and then cast a spell on the baby with chicken bones to ward off evil spirits. For $7.50 they could get double bat guano and chicken bones.

    But to get care for free, they only have to go to the internet.

    Medical care will regain respect when providers, including everyone from the billing clerk to the physician, bill for their time like lawyers and auto mechanics, and only accept cash or check for services rendered at the time of care, payable before exiting the premises.
    Patients will once again get what they pay for, and insurance companies will be squeezed out of the decision process for good.

    Delivery of that lesson should be billed by the original provider for another $514. 10% discount for cash.
    If the family squawks about it, they should be directed to seek a refund from whatever entity granted them a diploma, for failure to educate.

    The reporter should merely be swatted on the nose repeatedly with a wet newspaper until the lesson takes.

  4. I believe the mother probably appreciated the help and was thankful her child ended up fine, perhaps just a little disappointed about the $500 debt her family can not afford, that’s all. I don’t understand why everyone can’t relate to that.

    • The mother’s thanks, while a nice gesture, won’t pay the rent for all the highly skilled professionals who took care of her child.

      What I can’t relate to is anyone thinking you should be able to get that just for feeling thankful.

      Try that when the bill comes for a steak dinner, and tell me how it works out.
      Or just tell your boss you’ll work the next month just for the company’s appreciation and thanks.

      Everyone who comes in the door at the ED signs an agreement to pay the bill for services rendered. Then when it gets handed to them they spontaneously develop amnesia.
      The phenomenon happens so often it should be an article write-up in GomerBlog.

  5. I am sure you are a great ER doc and well respected by your peers, but your comments are typical of Doctors that get out of touch with reality. To suggest that the MDs, PAs and RNs in the “Doc-in-the-Box” clinic have lesser Licenses and that explains why you most often pay less for a minor visit is why so many people laugh at doctor’s arrogance.

    I have experienced decades of people in need of real and fixable medical help that beg to Not Be Taken to the Hospital for fear they (or their family if they die) will not being able to pay the bill. I witnessed a 2 day old broken hand of a child who’s family said they could not go to the ED unless the School Nurse felt is was broken because they did not have the money if it was just sprained. This isn’t child abuse, this is family survival for millions of people. They just did not get a $400K medical education and a guaranteed 6 figure income.

    Please imagine (even at your salary) if something happened this week and with ‘no choice’ you were presented with a $250,000 bill that not even insurance or bankruptcy could absolve you from paying. Would have more meaning for you? At least a 1,000 families a week get this bill (and larger) in the U.S.

    It has nothing to do with free birth control for insured patients. Lets try to have a little understanding.

    • @ Steven Hull
      1) If that comment was directed at me, I’m not an M.D., nor ever represented myself as such.
      2) I work 60+ hrs/wk in the Reality Department at several major local hospitals, where the department visit tallies range from 600,000 to 1M visits annually per facility.
      3) No one has suggested in any of the comments that the licensed professionals at urgent care “doc-in-the-box”es are inferior in expertise or practice, so I don’t know where you’re pulling that suggestion out of. The urgent care facility itself, however, is monumentally less capable of dealing with medical problems, by design.
      You pay less for a minor visit to urgent care because you’re getting less overhead for your money, and because you aren’t helping to cover the 19 uninsured indigent patients ahead of you who were deadbeats, but still cared for, because unlike an ED, urgent care clinics don’t fall under any of the back-breakingly onerous unfunded mandate provisions of EMTALA.
      And with your savings, you’re getting the double bargain of being billed for your services up-front, and the guarantee that if you need a higher level of care or more comprehensive treatment than a storefront clinic can provide, you’ll be referred to the ED anyways. Sometimes with a hefty critical care ambulance transport bill attached, just to spice things up, because it’s bad for business if you die in urgent care.
      This is only news to people who don’t know the medical field.
      4) The number of people who don’t pay their hospital bills is staggering. For the 4% who don’t, and give a crap about that fact, my heartfelt sympathies. For the other 96% deadbeats, a hearty boo frickin’ hoo.
      5) If you’re more worried about the hospital bill than you are about the future ability of your child to function with an untreated fracture, you should turn your children in to child protective services, go into counseling, and try to find a soul and a lick of common sense.
      Or probably at least suck it up and resolve to wait until the local urgent care or pediatric ortho clinic opens up in the morning, and be there when the doors open, provided your child has full circulation, sensation, and movement in the affected limb(s), and you can handle listening to them cry all night to save you a few bucks.
      6) Everyone has a choice. In 20 years, I have seen exactly zero patients dragged into a hospital kicking and screaming, and forcibly treated there against their will, who were not mentally incapable of making sound and rational judgments of any kind (in a legally defensible diagnosis of intoxication or acute psychiatric illness). So by all means, don’t come in, and then sign out AMA. Stay home, and the consequences be on your own head, without wasting everyone else’s valuable time better used to treat the patients who do come in. Welcome to how it works in the real world.
      7) IANAL, but as a general rule: Your family is not liable for your medical expenses if you get sick or die, unless the patient/deceased is their minor child. If they have legal power of attorney for the decisions they make on your behalf, your estate is liable.
      If there’s a spouse, half the estate is theirs, untouchable. So the hospital could collect as much as they can get from half the estate in such a case, and has to pound sand for the rest. The mob can threaten to come and break your legs for Uncle Bill’s debts; the hospital cannot force you to pay for his medical debts. And there isn’t any debtor’s prison, nor can they collect from you in perpetuity or despite bankruptcy. That privilege is reserved solely for the IRS, the state’s tax minions, and recipients of federally guaranteed college loans.
      8) So regarding that last: great job on putting the government in charge of all your health care now. Now if you don’t pay, it is more and more often a debt to the one entity allowed to hound you to the grave to pay your debts, and put you in prison for failure to pay. Thanks, Uncle Obama!
      9) Now you know why more and more hospitals and doctors are discovering that taking cash for treatment is king, and refusing any third-party insurance, and so your new co-pay is 100%.

      This how capitalism squirts out of government’s fingers, the tighter they squeeze the handful of jello.

  6. Just suggesting that we all can relate to an unexpected or unplanned debt being disappointing. The child was given care and treatment that was billed and definitely owed.

  7. Allen N Wollscheidt

    Ms Fuelner missed an opportunity to demonstrate the acute lack of common sense in our populace and in our medical community in particular.
    .
    To illustrate : Let us place the entire system of public roadways under the administration of and under the economic practices of the medical community — just for laughs — for one month.
    .
    Need ANY more be said ? ? ? . You will NOT be able to afford the cost of traveling to your employment. .Your billing for your one access to streets, roads and highways will be astronomical — in the tens of thousands — for the one shopping trip that you were forced to take or starve.

    • Not the same industries, dynamics, or economic considerations, so your comparison fails. Just one example: if roadways were like medicine, then municipalities could be sued for millions of dollars for failing to fix a pothole or for any accidents that occurred on the roadways. Then how many roads do you think would remain open?
      Medical care is expensive. I agree with you. But making disparate comparisons rather than looking at the reasons *why* medical care is expensive doesn’t do anyone any good.

      • Allen N Wollscheidt

        You look at the wrong factors : Roadways and Medical Care BOTH represent huge expenditures, relatively inelastic over time or use. . The concrete, iron and real estate and staff of both sit there whether they are used or not, incurring of course some yearly maintenance — which is a nit compared to the original investment. . So it is also with the Emergency Room : The costs are relatively fixed per day and are little influenced by the fact that a given patient indeed shows up. . The fact that the ER exists, Ready-to-Perform, for the known average level of demand, is of value to EVERYONE. . Therefore everyone should pay toward its sustenance, NOT just the User-of-the-Moment. Some limits could be invoked, but to hit a patient with a large bill unrelated to any NEW or incremental expenses incurred by the facility on his account just makes ZERO sense ! ! — Common OR Economic ! ! ! . In the case in point, a $50 contribution would likely have been cheerfully paid by a non-indigent. The rest comes out of the medical taxes, just like the gasoline tax.
        .
        By the way, medicare care IS expensive, granted — However far, FAR more so than is actually necessary were the industry to just get itself fully organized in a manner appropriate and effective for the 20th century, let alone the 21st. . It STILL runs as a cottage industry, in my lay opinion, and in my user opinion : I am 83.

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