А что если бы деньги не нашлись?
It was Labor Day weekend 2021 when Sara Walsh, who was 24 weeks pregnant with twins, began to experience severe lower back pain.
On Wednesday, a few days later, a maternal-fetal specialist near her home in Winter Haven, Florida, diagnosed Walsh with twin-to-twin transfusion syndrome, a rare complication that occurs when multiple fetuses share blood unevenly through the same placenta. The doctor told her that the fetuses were experiencing cardiac issues and that she should prepare for treatment the following day, Walsh said.
Her OB-GYN told her that, without immediate surgery, her twins had a high chance of perinatal death and she could also die.
Both doctors referred Walsh to a fetal surgeon about four hours away, describing him as an expert on the condition.
As Walsh prepared to leave, she received a call from the surgeon's practice, the Fetal Institute. Walsh said a billing representative told her that before Dr. Ruben Quintero would see her, she needed to pay in full for the consultation, surgery, and postoperative care - a total estimate of $15,000.
Although Walsh had insurance, the biller said the surgeon was not in any private insurance networks nor did he offer payment plans.
"I burst into tears," Walsh said. "I don't want to lose these babies."
Her mother agreed to give her money, and Walsh also called her insurer, who advised her to apply for a waiver that could allow them to reclassify the care as in network.
Late Wednesday, Walsh and her husband checked into a hotel near the practice's office in Coral Gables. The next morning, she handed her credit card and then her mother's credit card to the clerk at the Fetal Institute. Quintero said her case had advanced to stage 3, meaning there were problems that could cause heart failure in one or both fetuses.
He performed surgery later that day at a hospital about 90 minutes away. On Friday morning, she traveled back to his office for a follow-up. In the following weeks, she had two more consultations.
About five weeks after the surgery, Walsh gave birth to twin girls. They were premature but otherwise healthy.
Then she waited for her insurance reimbursement to come.
The patient: Sara Walsh, 39, is covered by Blue Cross and Blue Shield of Texas through her employer, a national newspaper publisher.
Medical service: Fetoscopic laser surgery for treatment of twin-to-twin transfusion syndrome, as well as pre- and postoperative evaluations and X-rays.
Service provider: The Fetal Institute in Coral Gables, Florida, a practice that specializes in treating rare pregnancy complications.
Total bill: $18,610 over multiple visits for surgery; pre- and post-surgical consultations; and two follow-up consultations for potential complications that didn't ultimately require more treatment. Walsh ended up putting $14,472.35 on her and her mother's credit cards. Her health plan eventually paid the Fetal Institute $5,419.44. Walsh was later partially reimbursed but ultimately paid more than $13,000 out-of-pocket.
What gives: Walsh's case falls into a gray area of medical billing between emergency and elective care. Despite being insured, Walsh paid most of the full charges upfront and out-of-pocket for care that three doctors said she urgently needed to save her twins. And she knew the surgeon was an out-of-network provider.
Within 20 hours, Walsh gathered the thousands of dollars she was told she needed to pay before the surgeon would meet with her and prepared to undergo surgery in an unfamiliar hospital. "That 20 hours was just insanity," she said.
Отсюда
Если коротко: как в Америке, имея страховку, попасть на деньги, причем не по своей вине. У женщины была сложная беременность близнецами и в какой-то момент они могли умереть (и заодно убить её саму), а доктор, который мог бы её спасти потребовал 15 штук вперед, как предоплату. Речь шла буквально о часах, ждать было нельзя. Деньги вперед и никакой рассрочки, "страховка потом заплатит" и всего этого. У женщины была хорошая страховка от работодателя, если что. Плати или умри. Родня помогла собрать деньги и спасла женщину. В конце концов, поскольку доктор был не из участников страховой компании, страховка заплатила примерно треть от конечной суммы, а 13 штук женщина была вынуждена платить из своего кармана. Просто вот так вот получилось. Никакой вины самой женщины.
И это - нормальная система? Не людоедская?
On Wednesday, a few days later, a maternal-fetal specialist near her home in Winter Haven, Florida, diagnosed Walsh with twin-to-twin transfusion syndrome, a rare complication that occurs when multiple fetuses share blood unevenly through the same placenta. The doctor told her that the fetuses were experiencing cardiac issues and that she should prepare for treatment the following day, Walsh said.
Her OB-GYN told her that, without immediate surgery, her twins had a high chance of perinatal death and she could also die.
Both doctors referred Walsh to a fetal surgeon about four hours away, describing him as an expert on the condition.
As Walsh prepared to leave, she received a call from the surgeon's practice, the Fetal Institute. Walsh said a billing representative told her that before Dr. Ruben Quintero would see her, she needed to pay in full for the consultation, surgery, and postoperative care - a total estimate of $15,000.
Although Walsh had insurance, the biller said the surgeon was not in any private insurance networks nor did he offer payment plans.
"I burst into tears," Walsh said. "I don't want to lose these babies."
Her mother agreed to give her money, and Walsh also called her insurer, who advised her to apply for a waiver that could allow them to reclassify the care as in network.
Late Wednesday, Walsh and her husband checked into a hotel near the practice's office in Coral Gables. The next morning, she handed her credit card and then her mother's credit card to the clerk at the Fetal Institute. Quintero said her case had advanced to stage 3, meaning there were problems that could cause heart failure in one or both fetuses.
He performed surgery later that day at a hospital about 90 minutes away. On Friday morning, she traveled back to his office for a follow-up. In the following weeks, she had two more consultations.
About five weeks after the surgery, Walsh gave birth to twin girls. They were premature but otherwise healthy.
Then she waited for her insurance reimbursement to come.
The patient: Sara Walsh, 39, is covered by Blue Cross and Blue Shield of Texas through her employer, a national newspaper publisher.
Medical service: Fetoscopic laser surgery for treatment of twin-to-twin transfusion syndrome, as well as pre- and postoperative evaluations and X-rays.
Service provider: The Fetal Institute in Coral Gables, Florida, a practice that specializes in treating rare pregnancy complications.
Total bill: $18,610 over multiple visits for surgery; pre- and post-surgical consultations; and two follow-up consultations for potential complications that didn't ultimately require more treatment. Walsh ended up putting $14,472.35 on her and her mother's credit cards. Her health plan eventually paid the Fetal Institute $5,419.44. Walsh was later partially reimbursed but ultimately paid more than $13,000 out-of-pocket.
What gives: Walsh's case falls into a gray area of medical billing between emergency and elective care. Despite being insured, Walsh paid most of the full charges upfront and out-of-pocket for care that three doctors said she urgently needed to save her twins. And she knew the surgeon was an out-of-network provider.
Within 20 hours, Walsh gathered the thousands of dollars she was told she needed to pay before the surgeon would meet with her and prepared to undergo surgery in an unfamiliar hospital. "That 20 hours was just insanity," she said.
Отсюда
Если коротко: как в Америке, имея страховку, попасть на деньги, причем не по своей вине. У женщины была сложная беременность близнецами и в какой-то момент они могли умереть (и заодно убить её саму), а доктор, который мог бы её спасти потребовал 15 штук вперед, как предоплату. Речь шла буквально о часах, ждать было нельзя. Деньги вперед и никакой рассрочки, "страховка потом заплатит" и всего этого. У женщины была хорошая страховка от работодателя, если что. Плати или умри. Родня помогла собрать деньги и спасла женщину. В конце концов, поскольку доктор был не из участников страховой компании, страховка заплатила примерно треть от конечной суммы, а 13 штук женщина была вынуждена платить из своего кармана. Просто вот так вот получилось. Никакой вины самой женщины.
И это - нормальная система? Не людоедская?