A young man came to our clinic today for ‘trouble sleeping’. He’s in his early 20. He looked pale and didn’t look so well *oh duh, otherwise he won’t be here*  He talked so soft you could barely hear him. His hands were crossed on his chest all the time he’s sitting in the waiting room, gesturing that he won’t take crap or pity from anybody. 10-15 minutes later, Dr. X came out with him and asked me to call the hospital to schedule an abdominal CT today for abdominal pain and questionable appendicitis.

“After you’re done, wait there and they will page me for the results,” Dr. X said to him. Meaning, if it is an emergency, he can be taken care of right away -surgery or hospitalization- then our doc will be notified.

He didn’t say a word. Not even a nod. Hands still crossed across his chest.

I contacted the hospital’s Radiology department and they were able to work him in soon. But when I told patient that he’s expected to be there in 90 minutes, he hesitated.

“I have to go home and talk to a family member to see if we can pay for this,” he said weakly.

“I’m sorry… I will have to call you back,” I told the Radiologist.

Instead of having him going back and forth, I suggested him to use our courtesy phone to call his family and tell them about this concern. That this is an emergency that needs to be taken care as soon as possible before it’s getting worse. While he was on the phone, I called the hospital back to talk to the Admitting Department. Surely, there is something they can do to help him out. I talked to a representative who is very helpful. According to her, the hospital usually doesn’t turn people away; that medical concerns come first. I told him that after he got off the phone.

“I don’t know… it’s like taking food away from our mouth,” he mumbled.

Dilemma #1: Do the procedure and work with the hospital for the payment plan or postpone procedure? Patient’s family owns a construction-type business, and they don’t have insurance. According to National Coalition on Health Care (NCHC), due to rising health insurance premiums, many small employers cannot afford to offer health benefits. Companies that do offer health insurance, often require employees to contribute a larger share toward their coverage. As a result, an increasing number of Americans have opted not to take advantage of job-based health insurance because they cannot afford it. I don’t know what his family were telling him and how he ended up feeling guilty having an abdominal CT today. If he doesn’t do it and his medical concern becomes out of hands, he might ended up with a larger bill anyways.

Dilemma #2: Make things easier for him or let it go? I would think, ethically, both of these medical institutions would feel obligated to help out. ‘No charge’ would be lovely, ain’t it? Take some burden off of his shoulders. But then, like our doc said, they will get used to this and will never try to apply for health insurance. Like the hospital rep had said, they will try to find a solution to help the payment less unbearable. So it’s not like he has to pay 100% of the charge. NCHC wrote,  hospitals provide about $34 billion worth of uncompensated care a year.

… 4 hours later. Patient called back from the hospital. Told me that the total cost was too much (not the payment paln) and asked me to consult the doctor, “How important is this procedure? It’s just on my side, not the whole stomach is in pain.” Apparently, he is trying to get out of it. I just hope he’s not going to end up in the ER tonight.

[More useful readings including how does being uninsured harm individuals and families can be found here]