NPR’s recent “Bill of the Month” highlighted a Montana man’s kidney dialysis that landed him with a bill of half a million dollars. The story describes how Sovereign Valentine, a 50-year-old personal trainer, discovered he was in kidney failure and in emergent need of dialysis. After discharge from the hospital, he and his physician wife returned to their small town in Montana and were told he’d need dialysis three times a week, with two options for treatment centers about 70 miles from their rural home.
They chose a center in Missoula, but soon after the outpatient treatments started, they were contacted by “an insurance case manager…warning them that since Fresenius was out of network, they could be required to pay whatever the insurer didn’t cover. The manager added that there were no in-network dialysis clinics in Montana, according to [his wife’s] handwritten notes from the conversation.”
Valentine’s physician wife attempted to get a quote on how much the dialysis might cost, but was unable to get a specific, or even rough, estimate. The NPR story highlights a law from 1973 that “allows all patients with end-stage renal disease like Sov to join Medicare, even if they’re younger than 65 — but only after a 90-day waiting period. During that time, patients are extremely vulnerable, medically and financially.” The outpatient dialysis center billed them $524,600.17. The NPR story notes that because of the law, there is “an incentive to treat as many privately insured patients as possible and to charge as much as they can before dialysis patients enroll in Medicare.”
Part of what is so disconcerting (and relatable for me personally) about this particular patient’s situation is that his wife is a physician, a person who would presumably have an advantage in navigating the system. She “knew it was important to find an in-network provider of dialysis.” Even with her extensive practical knowledge, she found herself and her loved one in an untenable situation.
Eventually, the patient’s wife contacted the state insurance commissioner and learned that there actually was an in-network dialysis clinic that had not turned up in other searches. Through this experience, Valentine discovered new insight into her patients’ challenges: “It’s very, very frustrating to be a patient, and it’s very disempowering to feel like you can’t make an informed choice because you can’t get the information you need.”
Writing Prompt: Have you had a time you were surprised by a medical bill, or found yourself ill and needing treatment when you didn’t have any health insurance? How did you feel? Consider writing a letter in second person to the insurance company, to the hospital, to yourself at that time, to the healthcare system as a whole. If you’re a medical provider, think of a time you tried to help a patient navigate the system regarding a medical bill. What was the experience like? Did anything surprise you? Write for 10 minutes.