Your ER Bill: A Bitter Pill (Or Why You Pay Through the Nose For Injuries to Toes)

Oh great.

This never even occured to me until I saw this ad.

All those times I ran into the back to grab a bite of the Super Garlic large pizza with extra garlic-flavored cheese on a garlic filled crust.....

Could I?

Do I?

Must I add Tic Tacs to my pocket arsenal of patient tools?

I suppose I could always say that it's an olfactory hallucination that always happens with chest pain or dyspnea or abdominal pain or stubbed toes.

You know, blame the patient.

Knowing me, I will now become fanatical about this and brush my teeth four times a shift and lose twenty pounds eating nothing but Certs for breakfast, Tic Tacs for lunch and Ice Breakers for dinner with a snack of Altoids in between.

But I will not give up my coffee or my diet Pepsi. A nurse has to take care of herself somehow!

hhhhhhhhhhhhhhhhhh

It's a holiday weekend. The doctor's office is closed

Besides, your doctor is on vacation anyway for two more weeks.

Your left big toe is three times its normal size secondary to an ingrown toenail you hoped would go away by itself but you dropped a desk on it and now you are in agony and really would like to walk without a scream escaping from your throat with each step.

You decide to go to the ER.

Welcome!

Have a seat in the triage room. If it isn't a crazy night, the nurse will take a look at your toe, commiserate with your suffering, grab you a wheelchair, elevate your foot, take some vitals, get a history and send you to registration.

Okay, your registration is complete and your nurse has your chart in hand and she calls your name. You are wheeled to your room, where you hop on the gurney.

Congratulations.

You have just spent a few hundred dollars.

The ER doc will see you, commiserate with your suffering but she knows what to do! After an x-ray to make sure you did not fracture your toe, your toe is numbed, your rather severely infected abcess is drained and the offending nail is cut out.

Your nurse places a gauze bandage on your toe. You may need a cast shoe for comfort for a few days.

It's sort of late by now and your doctor wants to save you the trouble of going to the pharmacy so she asks the nurse to give you your first dose of antibiotic before you leave.

Congratulations.

You just spent a considerably few hundred dollars more.

You are given your discharge instructions, prescription and told to follow up with the doctor on call for yours in two days to recheck the wound and make sure it's healing well.

Thanks for using our Most Excellent ER! Take care!

ddd

Six weeks later you get the bill from the Most Excellent ER and it is well over one-thousand dollars.

After you pick yourself up off the floor, you look at the bill to see where it says they gave you a heart transplant, because surely an ingrown toenail can't have cost that much!

But it does.

That charge includes:

• the triage, the registration, the "room charge" which is based on your initial complaint

• the medications used to numb you and the antibiotic used to treat you which were obtained from the drug dispenser maintained by pharmacy

• the disposable instrument tray used to cut you, the gauze used to bandage you and the cast shoe used to help you obtained from the equipment dispenser maintained by central supply

• the nurse who went over your discharge instructions (and was assigned to your care)

• the fact that you had a procedure (the incision and drainage of your infected foot).

But still, you say, over one-thousand dollars?

Yep.

Because you took advantage of a service that is available to everyone who needs it, twenty-four hours and a day, seven days a week. The ER. Your bill pays for the salaries of those four RNs and one tech who are there whether there is one patient in the department or twenty patients every hour or none at all during a night shift. Your bill covers the services of those who have no insurance but never pay their bill, those who are indigent, or homeless and post-cardiac arrest.

You are paying for the advantage of having, and using a 24/7 emergency health care operation.

Oh, and by the way, the ER doctor and the x-ray department radiologist (the specialist who will ultimately read your x-ray officially) bill separately. They are not employees of the hospital.

ddd

Now I gave an example of someone who really had no other choice. This infection could have turned serious very fast and they were in excruciating pain. I added the element of the x-ray to make a point.

It doesn't make economic sense to use an emergency department for a non-emergent problem. If you aren't sure what constitutes an emergency, or if your pain is umbearable, we are there for you. Don't take a chance.

But...if you are not in any danger of losing your life, limb or eyesight

• Call your doctor, even after hours. Speak to whomever is on call. See if they have some advice they can give you over the phone. They may say, go to the ER! If so, come on down!

• Wait until office hours the next day, if you can. That sore throat you've had for a week will not go away just because you visit an ER that night. Trust me. Even if we start treatment, you won't be immediately cured. You may have to go through a possibly lengthy ER wait/visit when your doc may have been able to fit you in.

• If you feel you are not having an emergency but must be seen, and if you have access to an Urgent Care Center (often called a "Doc-In-The-Box" as a joke), use it. It will be cheaper and hopefully faster than most ERs.

ddd

An Emergency Department is there to care for anyone and everyone who needs their services.

No one can be turned away.

It can be a lifesaver or it can be one very expensive band-aid.

If you need the ER, use it! If you have another option, you'll save time and money.