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On the American healthcare bureaucracy

Updated on November 4, 2015

Classic, ridiculous bill for the emergency room

Who needed the emergency room and was rewarded with an astronomical bill for a simple ECG? My hand raises slowly. That wasn't entirely my fault though... After waiting 20 minutes on the phone, the nurse had told me that the strong pain I had in my chest could have been something really bad. Call 911! She said. What could I do? Probably I should just have waited until morning, taken the plane that was ready to take me back to Italy (yes, I had a flight to home the day after), and hoped not to die on the plane. But hey, when a nurse tells you that it may be a heart attack, I assure you that you take it quite seriously. The fact that at the time I did not have any health insurance is another story, again due to bad bureaucracy, but in this case the US visa offices are to blame. And we complain about Italian bureaucracy... Anyways.

I go to the emergency room (first time in my entire life), I immediately say that I don't have any health insurance. They just tell me hey don't worry, we'll take care of you anyway. Sure they did. The two nurses coldly measured my temperature, asked me a thousand questions about my situation, then called the physician, who took a look at my ECG, took my blood for one single test, spent more or less 7 minutes talking to me and then left me saying that it was probably something muscular. I learned only two months later that my fifth left rib was subluxed. A hell of a doctor. In all this time I was surprised that nobody had talked to me about the bill! That was the moment when this short, bald guy entered the room and informed me that the bill would actually arrive at my US address. When he said that just walking by the emergency room door costed $400 I'm pretty sure that my ECG had a drop. Disconsolate, I went back home and waited for the verdict. Which, inevitably, arrived. $2380 for the hospital. $1250 for the physician. I seriously thought of changing my identity and run for my life. Then my boyfriend convinced me to try and solve what we will call you, from now on, "that small health care problem".

The charity option

If you ever got a bill that you cannot pay, you probably know that there is this nice service, invariably run by an unintelligible man who speaks at 200 mph, where you can ask for a discount. Only for the hospital, obviously. So I started from there. This guy asked for my W-2 and assured me that I was probably going to get a 90% discount thanks to charity. Which seemed pretty good to me! So I immediately sent everything he asked, and I waited. In the meantime, I had called the physician office, which was becoming quite pressing, to ask them to wait for the hospital discount. They told me that they needed a letter from the hospital confirming the discount, and only then they would be able to make a discount as well. That sounded good too. One month passed. I called the guy again. He didn't answer. His answering machine told me to call two other numbers. I called all of them. For four days. I left more or less polite messages to their answering machines. Nobody ever answered nor called back. I lost my patience. I sent an email to the guy (lucky for me I had his email!), who gave me a fourth, different number to call. After the usual wait on the phone, made more pleasant by a precious piece from Bach (...), they told me that it was going to take 20 days more. Three more months passed. I went back to Italy for good, as my contract with the university had finally terminated, thinking that the hospital and the physician could very well go to hell. You would say, end of the story, right? No, that's not right.

The debt collection agency convinced me not to give up...

Any good story needs a little bit of violence, right? Just look at Games of Thrones... So I went back to the US two months later to visit my boyfriend. As soon as I put my US SIM in my phone I get a call from those people who break your thumbs. You know Rocky Balboa, right? Eeeerrrr my calls started again. I was very resolute this time! I wanted to get rid of "that small health care problem" for good, and I had 24 days to do so (long vacation, I know). I called the hospital the first time, and they surprisingly told me that I had got 100% discount! It really seemed too good to be true! So I asked them to please send me a letter, to my boyfriend's address, saying that I got this discount. I specified that I needed that for the physician office, which in the meantime had told me that they would apply the same discount on their side. The guy I talked to, told me that the letter would arrive in a couple of days. A week passed. I called again. This time I talked to a girl, who spent almost 40 minutes trying to break into the hospital system to re-send the letter I was asking for. I again specified that they should send the letter to my boyfriend's address, which I patiently repeated. She told me that it would take a week to arrive. Two more weeks passed. 21 days already, and I didn't even solve the first half of my small health care problem! I called a third time. Instead of specifying the address this time, I asked the girl what address they had. I still hear her spelling my bloody old address. For God's sake! I explained to her everything again, I spelled my boyfriend's address for the millionth time, but in truth I had lost my faith that the situation would be solved before my departure. And indeed, I got back to Italy. However, a week later my boyfriend called me to tell me that a letter had arrived for me! I didn't dare to believe it! He opened it and he read it to me. The letter said, literally: we confirm that you have zero balance. Thanks for choosing our emergency room. Zero balance. No mention of the 100% discount, which I very clearly said I needed stated. Funniest thing is, the address they sent the letter to was spelled wrong. The only fact that the letter arrived to the right address was a miracle. A useless miracle, because I will have to call them again from Italy now, and I'm not sure I'll be able to maintain my proverbial composure.

Some polemic, if it wasn't enough

And now we get to the core. Let's forget about the fact that paying $4000 for an ECG is simply a madness. Let's forget about the fact that, suddenly, the physician office allows 100% discount without a blink, if the hospital did the same. It says something about what the bills should actually look like. Let's just forget about the health care system (even though there is much to say) and let's stick to the bureaucracy issue. What the hell is your problem with technology? Did you even realize that there are emails now? That the useless piece of paper that you made fly all across the US in God knows how many days could actually be mine with the time of a click? But no, you have to use the bloody postal service, and you are not even able to transcribe right the address I slowly spelled multiple times! How is it possible that we can get food, clothes, the weirdest accessories with a click and in only two days (if you are a lucky Amazon Prime member), but we are still bound to talk to an unlimited number of idiots before even being able to get a useless piece of paper when it comes to the serious things? And I won't even talk about the infinite lines for the SSN, the shocking marathons just to be able to rent an apartment before someone else, or the honestly primitive bureaucratic system to get a driver license (the fact that I already had an Italian driver license didn't help at all).

Now, Forbes 2013 tells us that "Unpaid Hospital Bills Rise To $41 Billion Annually". Apart from the fact that the bills are absurdly astronomical, would you really want to waste all this time trying desperately to pay them?

Do you find the American bureaucracy efficient?

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