My phone rang yet again with another frustrated, angry person dealing with a pricey emergency room bill. As a patient advocate, I spend a great deal of time calming people down who are very upset when they receive an expensive medical bill after a quick trip to get emergency care. Typically, they have some urgent, yet minor, medical problem and they have managed to go the wrong place for what they truly need. With some basic understanding and education about emergency care facilities, these stories might have had happy endings; instead, these people now have a new source of stress in their lives.
This particular client’s problem began with a common misunderstanding. In 2009, to alleviate the overcrowding in our ERs, the Texas legislature allowed the formation of freestanding ERs (FERs)—ones that would not be physically connected to hospitals. Yet, no attempt was made to educate the public as to the difference between the existing urgent care clinics and these newly formed FERs as to when to use each type of facility. Trouble starts when people go to the FERs for minor medical problems, thinking that they are going to an urgent care clinic. Instead of a $150-300 urgent care bill for a minor problem, bills from the FERs will be upwards of $1200 or more for using the services of a facility that is open 365/24/7 and has a board-certified emergency medicine doctor available at all times. In addition, in the heat of the moment when people are searching for urgent or emergency health care, they generally fail to check their insurance coverage details—leading, once again, to frustration afterwards.
Even worse, for truly major medical problems, I learned that most people do not know the difference between the various levels of trauma ERs, the levels of care for stroke ERs or the different provisions for cardiac emergency services.
Clearly, my new mission had surfaced. I went to work and dove into the details to sort out various scenarios here in Houston. I knew I wanted to teach people what to do, to give them information to help them make decisions on the front end to avoid costly mistakes later—both medical and financial. It has become my ongoing project to assemble all this information into a presentation that will encourage people to plan ahead for emergencies, instead of just hopping in their car and speeding away to the nearest health care facility. As the late, great Yogi Berra said, “If you don’t know where you are going, you’ll end up someplace else.” And I would add, “with the wrong care and a large medical bill.” Only a groundswell of educated consumers will be able to lead the way to a better and brighter future in health care. Step by step, person by person, I hope to play a part in this movement to help people achieve the affordable medical care they need. It’s the only way for all of us to truly live happily ever after.
Bonnie Sheeran’s essay was submitted as part of the 2015 Costs of Care, HFMA, Strata Decision Technology, and Yale New Haven Health’s contest entitled The Best Care, The Lowest Cost – One Idea at a Time.