ER = PCP

Avatar for ddnlj
iVillage Member
Registered: 03-26-2003
ER = PCP
31
Wed, 11-04-2009 - 8:07am
Big bills follow ER visits



  • BY MARTHA QUILLIN - Staff Writer





With her diabetes, high blood pressure and cholesterol under control, Gail Johnson expects to be around to see her grandchildren grow up. But the 56-year-old figures she'll die long before she's able to pay off her hospital bills.


"I don't even know how much I owe WakeMed. That's how bad it is," she says, guessing it's well over $20,000.









Johnson amassed that debt doing what uninsured Americans do millions of times each year when they get sick: Go to a hospital emergency room.


Emergency rooms have become the U.S. health care system's safety net, where anyone can go for treatment and no one can be turned away because they can't pay in advance.


But experts say using emergency care in place of checkups and doctor visits is the most expensive way to deal with chronic illness. Many of the 119.2 million emergency visits racked up in 2006 were for problems that could have been prevented through regular primary care. More than 17 percent of those visits - nearly 21 million - were made by patients who had no insurance, according to the National Center for Health Statistics.


The average emergency room bill is about $1,300; much more if the patient is admitted. A visit to a doctor's office starts around $75.


But hospitals are required to take patients who have no insurance and no ability to pay; they bill later and hope to collect. Doctors' offices require proof of insurance or payment at the time of service.


Johnson's was a typical case.


During her 27-year marriage, she says, she was insured through her husband's policy at work. When they split up more than a decade ago, she lost her coverage. She found work, but never with benefits.


So she went years without going to a doctor, a dentist or an ophthalmologist. She didn't realize her blood sugar was out of whack, and her blood pressure and cholesterol were rising. The first time she went to the WakeMed emergency room, she had a major kidney infection and severe dehydration.


Emergency physicians got Johnson stabilized and referred her to an endocrinology practice in Raleigh. At about $80 each, office visits cost more than a fourth of Johnson's weekly take-home pay. Johnson filled her prescriptions when she had the money.


But most of the time, medications she was supposed to take daily, she took every other day or every other week to make them last, a practice her doctor later said would tax her kidneys worse than taking none at all.


Once when she checked her blood sugar at home, the meter pegged at the top of the scale. Her blood sugar had gone off the chart. She was at risk for a stroke.


For several years, Johnson went to the emergency room one to three times a year, not uncommon for uninsured patients, according to the Center for Health Statistics.


An unhealthy cycle


Nearly six years ago, Johnson got a data-entry job at a mortgage-servicing company in Garner with about 10 employees. The owner has looked into providing health insurance for the staff several times. But each time, Johnson says, the rep comes in, looks over the applications of the mostly young and healthy staff, then stops at Johnson's.


"I throw the whole thing off," she says, "because of my age and pre-existing conditions."


One health care reform proposal would help people buy insurance through an "exchange" whose companies could not deny coverage or price it exorbitantly because of pre-existing conditions.


Johnson sees another possible solution: the proliferation of places like Alliance Medical Ministry, a nonprofit that opened in 2003 nearWakeMed in Raleigh to provide affordable primary care to the working poor.


Dr. Tara Lewis, medical director for Alliance, says about 90 percent of the patients who come for treatment have no insurance and no regular doctor, and have been off needed medications so long they have gotten sick enough to require a trip to an emergency room. After treating them, ER staff now send many of their patients to Alliance to try to break that cycle.


Lewis, a small staff of part-time physicians and 250 volunteers work with about 7,500 patients in a renovated church. In addition, Alliance operates an acute-care clinic for same-day visits. Acute care costs $25. Primary-care visits are charged on a sliding scale; most are $15 each.


Alliance doctors can't do everything, and every day Lewis sees patients who need a specialist's care and can't afford it.


"We hear it all the time," Lewis says. "We want to order a test, and the first question is, 'How much is that going to cost?'"


So the cycle begins again, Lewis says.


When patients repeatedly ignore health problems until they have an emergency, their overall health suffers and everyone's costs increase, including those of insured patients who help absorb the hospital costs of those who can't pay.


Still not in the clear


Johnson, the patient, thinks she owes her life to Alliance doctors. Regular visits and counseling on how to manage her diabetes probably averted a stroke or heart attack, she says. And just as important, she says, "Alliance gave me my dignity back."


Lately, though, Johnson has been retaining fluid and her blood pressure has been unstable. She needs a chest X-ray and an electrocardiogram. Another trip to WakeMed, another bill she can't pay.


It's been at least three weeks. She still hasn't made the appointment.


martha.quillin@ newsobserver.com or 919-829-8989
Photo Sharing and Video Hosting at Photobucket

Pages

iVillage Member
Registered: 03-18-2000
In reply to: ddnlj
Wed, 11-04-2009 - 9:13am
What a desperate situation. She's just one

 


Photobucket&nbs

iVillage Member
Registered: 03-16-2007
In reply to: ddnlj
Wed, 11-04-2009 - 11:58am

There are thousands of stories like this, many I know of in real life. It's so frustrating. I have a friend who just lost their insurance, because her husbands boss couldn't afford it anymore. Three weeks later, she had to have her appendix removed. :(

Photobucket
iVillage Member
Registered: 02-19-2008
In reply to: ddnlj
Wed, 11-04-2009 - 12:07pm

"During her 27-year marriage, she says, she was insured through her husband's policy at work. When they split up more than a decade ago, she lost her coverage. She found work, but never with benefits."

So without a man or an employer to manage her life she is an incompetent?

Avatar for ddnlj
iVillage Member
Registered: 03-26-2003
In reply to: ddnlj
Wed, 11-04-2009 - 12:29pm

Maybe it never occurred to you because you've always had a well-paying job, that some people can't AFFORD health insurance.

Photo Sharing and Video Hosting at Photobucket
iVillage Member
Registered: 02-19-2008
In reply to: ddnlj
Wed, 11-04-2009 - 12:35pm

Maybe it never occurred to you because you've always had a well-paying job, that some people can't AFFORD health insurance."

I've always had a well-paying job? How come I'm always the last to know these things?

With regards to affording insurance, it was more a matter of not being able to afford not having it. How much debt has this woman accumulated that she fears never being able to afford paying it off?

iVillage Member
Registered: 02-19-2008
In reply to: ddnlj
Wed, 11-04-2009 - 12:38pm

"So she went years without going to a doctor, a dentist or an ophthalmologist."

It would appear she also went years without doing anything about her uninsured state, unless this article has left something out. That is not a smart choice.

Avatar for claddagh49
iVillage Member
Registered: 07-20-2004
In reply to: ddnlj
Wed, 11-04-2009 - 2:09pm
*
iVillage Member
Registered: 02-19-2008
In reply to: ddnlj
Wed, 11-04-2009 - 4:42pm
What can I tell you .... people make bad lifestyle choices all the time. Generally we don't respond by trying to grab control of an entire industry to accommodate it.
iVillage Member
Registered: 02-19-2008
In reply to: ddnlj
Wed, 11-04-2009 - 6:29pm

"When I got divorced my first job paid $8.00 lousy dollars an hour. I had a kid to raise and a home to take care of and it was only because I was under my ex's COBRA plan, which he paid for, that I had insurance at all at that time."

If I recall correctly your ex up and decided to walk out on you and your child. It is not unreasonable that he should have had to pay for health insurance after electing to do this.

Avatar for ddnlj
iVillage Member
Registered: 03-26-2003
In reply to: ddnlj
Thu, 11-05-2009 - 8:37am

Can you maybe explain then why when an industry makes bad choices WE THE PEOPLE are required to ACCOMMODATE IT?

Photo Sharing and Video Hosting at Photobucket

Pages