Drastic Times

On the evening of March 1, 2008, Gary Diego had to rush his wife to the hospital for an abrupt medical emergency. Insured, Diego rushed her to his insurance company’s in-network hospital. Unable to handle what was determined to be bleeding in the brain, the hospital quickly transferred her to Renown Regional Medical Center in Reno, Neveda, where she spent 17 days in intensive care. While recovering, she caught pneumonia and died.

As the Reno hospital was not in his insurer's approved network, Diego learned from his insurer, Health Net, that he owed $75,462.77 in out of network charges. Further bills continued to arrive as Diego discovered that he also owed money to out-of-network doctors and testing laboratories for services not covered by insurance. All of this was on top of a $14,000 deductible he had chosen to keep his premiums down.

The article describing Diego's plight (which can be read in its entirety here), explains that in a practice known as balance billing, insurers pay a portion of the out-of-network charges, and the balance owed to hospitals and doctors is dumped on patients.

The article states as follows:

Until recently, the problems associated with out-of-network emergency care had received little attention. But now they’re being attacked on multiple fronts, with insurers, hospitals and doctors pointing fingers at each other, and patients stranded in the middle.

On Aug. 12, an insurance industry trade group released a report saying some out-of-network doctors and charge much more than the negotiated fee they would collect in a network.

The group, America’s Health Insurance Plans, noted that out-of-network fees are not regulated and asked Congress to investigate the issue. None of the leading reform bills addresses the issue now

As stated in the article, Diego's case is an extreme example. As also stated in the article, consumers who are careful to choose in-network doctors and hospitals for their routine medical care often cannot choose where or how they are treated in an emergency. Even non-life-threatening emergencies when vacationing or visiting out of state can cause financial ruin, even for those with insurance.


And sometimes, even if patients are careful to remain within the network of their insurance provider, they can still incur additional costs. According to Dr. Richard Duszak, a radiologist in private practice in Memphis, Tenn., and an official with the American College of Radiology. “They (hospitals) tell you that they are an in-network provider, but they don’t tell you that the emergency room physicians are not in the network.”

With the current system that we have in America, unless we are extremely well off financially, we find ourselves dependent upon and at the mercy of our insurance providers. Yet despite being only a medical emergency away from financial disaster, opponents of universal health care continue to oppose it for fear of government takeover or lack of independence.

What universal health care would offer is peace of mind that we and our families could receive necessary treatment and care without the worry of how we could afford it. Having lived for years in the UK, where such a system is in place (NHS), I can report firsthand that I was free to choose my own doctor, discuss my treatment and medications with my doctor, see a specialist within a week, and have preventive procedures preformed at the local hospital with a wait of no more than a month. The taxes that I paid for access to the system were less than my group insurance premiums here in the USA. And all without hidden or additional costs such as co-pays, deductibles and out-of-network fees. If I or a family member fell ill on the other end of the country, our medical coverage was still in force, as it was if we became unemployed or retired. And our children remained covered, regardless of their age or student status.

And most of all, no one told me how to run my life. My standard of living was equal to or higher than in America, and I enjoyed the same freedoms that we have here (barring a "right" to carry handguns).

The bottom line is that universal health care would benefit not only the uninsured, but all who have to depend on insurance companies for their medical expenses.