Your kid's ear hurts at night. You call the doctor's office. A recording tells you to hang up and call 911 or go to the nearest emergency room. So you go. Weeks later the bill arrives, and it's a shock. A former ER doctor wrote to the Journal this week to explain why.
John Barchilon, M.D., of Estero, Fla., used to work as an emergency-room doctor. In a letter on the Journal's opinion page, he answers an Oct. 12 letter from ER physician Laura Daymut. Her point was that the way to keep medical bills low is to stay out of the ER. He agrees, and says she skipped the reason people end up there. In his words, outpatient communication between doctors and patients "has been blocked."
What changed
He remembers a different system. A patient phoned their own doctor first. The doctor gave advice, or sent them to the ER and called ahead to order tests. There was little waiting. Then the corporate practice of medicine doctrine took hold, he writes. Insurers saw no reason to pay for two doctors on one ER visit. The fix was to cut your own doctor out of the loop. Now you can't reach that doctor after hours, and often not during the day either. He says no one wants the ER trip, but the doctrine leaves them no other door. Then it bills you at up to 20 times the outpatient rate.
We'll be fair about that number. It's one doctor's claim in a letter, and the Journal prints it as opinion. Hospital billing varies a lot by state, by plan and by what's done to you. But every reader with a deductible knows the direction. The same sore throat costs more through the ER door than through the clinic door.
Our read
Health Costs. For a true emergency, go to the ER. For everything else, the cheapest visit is the one you planned before you got sick. Many health plans run a free round-the-clock nurse line. Many clinics now offer same-day or video visits. Urgent care sits between the clinic and the ER on price. If you're on Medicare, the ER door and the clinic door can land in different parts of your coverage, with different bills. If you're on a high-deductible plan, you feel the whole gap until the deductible is met. Either way, the choice of door is a money decision you make in about ten seconds, usually while scared.
The one thing in your plan this touches is the after-hours page of your health coverage. The one check this week is to find it. Write down the nurse-line number, the nearest urgent care and its hours, and your plan's telehealth option. Put the card on the fridge and the numbers in your phone. Then, when the ear hurts at 10 p.m., you'll make one cheap call before the expensive drive. Bring the card to the next review and we'll fit it into your health-cost line. You don't wait for the fever to look up the doctor.