By Markian Hawryluk Photos by
Heidi de Marco November
26, 2019
It was supposed to
be a fun evening out for Katy and Michael Branson. But their 3-year-old
daughter, Lucy, apparently had other ideas.
The couple had
tickets for a Saturday night show in April in their hometown of Las Vegas, and
had arranged for a sitter to watch their two girls. But as Mom and Dad were
getting dressed, Lucy came upstairs to their bedroom coughing and looking
rather uncomfortable.
“I think she has
something up her nose,” Michael said.
For reasons she
couldn’t quite explain, Lucy had shoved a matching pair of pink Polly Pocket
doll shoes up her nose — one in each nostril.
Her parents tried
to get her to blow her nose to dislodge the plastic footwear, but Lucy could do
no better than a few sniffs. Katy found a pair of tweezers and was able to
remove one shoe, but the second was too far up Lucy’s tiny nose for them to
reach.
Michael took Lucy
to a nearby urgent care center, where the doctors had no more luck with the
tweezers — called forceps in medical parlance — they had on hand and suggested
he take her to the emergency room. There, a doctor was able to remove the shoe
in less than a second, as Michael recalled it, with a longer set of forceps.
The doctor typically finds Tic Tac mints up there, he told them. This was his
first doll shoe extraction.
“All in all, it was
an eventful evening,” Katy said. “My husband makes it back, we go to the show,
my daughter’s fine.”
The Bransons figured
they had weathered another typical night of parenting and didn’t give it much
more thought. Then the bill came.
The Patient: Lucy Branson, now
4, a precocious preschooler with a fondness for any sort of doll. She’s insured
through her father’s high-deductible plan with UnitedHealthcare.
Total Bill: $2,658.98,
consisting of a $1,732 hospital bill and a $926.98 physician bill.
Service Provider: St. Rose
Dominican, Siena Campus, in Henderson, Nev., part of the not-for-profit Dignity
Health hospital system.
Medical Procedure: Removal of a
foreign body in the nose, using forceps.
What Gives: The Bransons
negotiated a reduction of the physician’s bill by half by agreeing to pay
within 20 days. But Dignity Health declined multiple requests for an interview
or to explain how it arrived at the $1,732 total for the ER visit.
“Not every urgent
situation is an emergency,” the hospital said in an emailed statement. “It is
important for patients to understand the terms of their health insurance before
seeking treatment. For example, those with high-deductible plans may want to
consider urgent care centers in nonemergency situations.”
The hospital billed
the Bransons $1,143 for the emergency room visit and $589 for removing the
shoe. The entire $1,732 hospital bill was applied against their deductible.
For public health
plans like Medicare or Medicaid, the hospital generally bills an average of
$526 for removing a foreign body from the nose and gets an average payment of
$101, according to WellRithms, a medical billing review firm.
According to cost
reports submitted to Medicare, the hospital’s average cost for the procedure
comes to less than $48. That’s less than a quarter of the $222 fee WellRithms
recommended and well below the $589 St. Rose charged the Bransons.
The Bransons had
options as they chose their employer-sponsored health plan. They picked one
with a high deductible of $6,000 per year. So instead of paying $500 more a
month in premiums, the family could pocket that difference if they avoided any
major health problems.
“I’d rather gamble
that I might have to pay it, versus commit to paying it every month,” Katy
said.
The Bransons were
ready to cover the full deductible for any emergency that might arise. They
just never thought something as simple as extracting a plastic shoe with
tweezers would garner such a big bill.
Removing a foreign
body from a child’s nose or ear is a fairly common procedure in emergency
rooms, with the variety of objects removed from noses limited only by the size
of the nostrils.
“Kids like to put
things in their nose or their ears, for whatever reason,” said Dr. Melissa
Scholes, an ear, nose and throat specialist with the University of Colorado
School of Medicine.
Scholes recently
reviewed records from 102 children who came to Children’s Hospital Colorado
from 2007 to 2012 with objects stuck in their noses. About a third of those
patients were referred to an ear, nose and throat clinic, and about half of
those required surgery to remove the object. Doctors were able to remove the
object in the emergency room in the remaining two-thirds of cases.
Scholes said
pediatricians don’t often have the necessary tools to remove the object. Those
can include extra-long tweezers or a catheter with a balloon on the end. The
tip of the catheter is snaked past the object then the balloon is inflated and
the catheter is pulled out, dislodging the foreign body.
“People don’t
really have a good grasp of the anatomy of the nose, because a lot of people
think it’s just like a tube,” Scholes said. “It’s a big cave once you get past
the nostrils. So once things get back far enough, you kind of lose them.”
Resolution: The Bransons are
still fighting to get a detailed explanation of how Dignity Health calculated
its bill.
“It’s not even so
much that we can’t pay that if we absolutely have to,” Katy Branson said. “It
doesn’t make sense that it costs that much. A human being needs to look at this
and say, ‘WTF? Why are we charging $3,000 to take a Barbie shoe out of the kid’s
nose?’” (WTF, in this case, stands for “Why the fee?”)
After all, Katy
doesn’t own a single pair of shoes worth anywhere close to $3,000 herself.
“Well, apparently,
now I have one,” she said. “But they’re not in my closet; they’re in the
playroom.”
The Takeaway: Check with your
doctor if you can about whether a medical issue constitutes an emergency or if
it can wait until morning.
Sometimes your
pediatrician’s office can recommend a do-it-yourself method for removing an
object in the nose to avoid a costly emergency room visit.
In what’s known as
the “mother’s kiss,” Mom covers the child’s mouth with her mouth to form a
seal, blocks the clear nostril with her finger then blows into the mouth. The
pressure from the breath may then expel the object. (The technique works
equally well when performed by dads.)
For parents whose
children have put things up their noses: Scholes said such objects rarely move
much and can generally wait until an appointment the next morning. Having the
object removed without the ER facility fee will be cheaper.
In terms of the
bill, the Bransons were smart to negotiate right away, and they succeeded in
getting a significant discount from the original. Many hospitals offer what
they like to call “prompt-pay discounts” (often 10% to 25%). For hospitals,
getting the cash quickly is valuable, and even billing clerks may be able to
approve the discount on the spot.
But don’t jump at
the first discount they offer. And don’t let an outrageous bill sit on the
kitchen table as you get angrier and angrier. Start haggling and hassling ― and
keep it up. After all, a 25% discount off a highly inflated bill results in one
that is only slightly less outrageous, as the Bransons found out the hard way.
NPR produced and
edited the interview with KHN Editor-in-Chief Elisabeth Rosenthal for
broadcast. Stephanie O’Neill provided audio reporting.
Bill of the Month
is a crowdsourced investigation by Kaiser Health News
and NPR
that dissects and explains medical bills. Do you have an interesting medical
bill you want to share with us? Tell us about it!
Markian Hawryluk: MarkianH@kff.org, @MarkianHawryluk
Heidi de Marco: heidid@kff.org, @Heidi_deMarco
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