Wednesday, March 30, 2016

A Warning About the Emergency Room Insurance Coverage

In March 2000, the staff at the emergency room in what was then Lockport Memorial Hospital saved my life. I had a rapidly spreading infection that threatened to prevent me from seeing the sunrise the next day, and the staff went to work prepping me for surgery and bringing in a talented surgeon to take care of the job. Ever since then, I have been one of the hospital's staunchest supporters. But that support took a big hit recently over something I think should be illegal for any hospital to do.

That hospital has always been there whenever I needed it, and I never had an issue with anything that went on there. The unofficial Facebook page for ENH has a long list of one and two-star ratings that I simply could not understand. In my eyes, that hospital could do no wrong. Even in my recent experiences with ENH, I found it to be a good hospital. I had a friend of mine go in there for treatment and, from what he told me, he was treated pretty well.

I know ENH has undergone some changes over the past few years, but I did not see those changes affecting the level of service. I personally know people who have gone back and forth with ENH on employment issues because ENH was constantly trying to find the cheapest way to provide care for the community. One of the most important services ENH offers to the community is its emergency room, and this is where I noticed most of the problems were happening. Now after what has happened to me, I think it is time to become more educated on health insurance and how it works.

I have stage 4 kidney cancer and had my right kidney out in early January. Since then, my entire life has changed. This type of surgery also has a tendency to mess with your body, and changes are inevitable. During my adjustment period after my surgery, I started to have issues with my digestive system. It got so bad that my son rushed me to the ENH ER in late January with what can only be described as the worst pain I have ever felt in my life.

On the way to the hospital, I started to get a metal taste in my mouth, which I know is not good. To their credit, the people at ENH got me into an examination room immediately. I was begging for a doctor to come look at me and finally, almost 45 minutes later, one did. He diagnosed the problem and fixed it. I was extremely grateful and left ENH with yet another high opinion of its ER. 

Two weeks ago I received the co-pay bill from the hospital. It was twice as much as I was expecting, but that is because of changes in my insurance that I was not aware of. I was all prepared to pay my bill this Monday when I received another bill for the treatment I received that day. It was a bill that completely changed the way I feel about health insurance, and it is a bill that prompted this warning to the public.

I had no idea that the doctor who treated me that day was out-of-network for my insurance company. The hospital never told me, and the doctor never told me. Last Saturday I received a bill for nearly $650 in doctor fees for what amounted to 30 minutes worth of treatment. I looked it up, and the bill could very well be legit. I am still going to fight it because I had no idea that such a thing could happen.

My point about ENH is more of disappointment than anything else. When you go to the emergency room in pain or serious discomfort, you must chose to get treated by the doctor on-call regardless of the insurance situation. In some cases, the insurance company will pay that extra bill. But in many cases they won't. How is that fair to people who legitimately need to use the emergency room? Here was the perfect chance for ENH to be a pioneer and develop a system that could at least warn patients about this possibility instead of just putting it in the fine print like everyone else. But instead, ENH chooses the covert method and their patients all suffer.

I hope this warning helps people in some way. I hope people learn to ask questions to prevent a potential healthcare bill they cannot afford. I also hope that hospitals such as ENH seize on an opportunity to improve their status in the eyes of their communities and do what they can to prevent their patients from being taken in by an act that can only be described as deceit on the part of the healthcare provider and the powerful insurance companies.

George N Root III is a Lockport resident who learned a lesson about health insurance the hard way. Follow him on Twitter @georgenroot3 or send him a message at Sorry ENH, you left me no choice with these business tactics of yours.