By Consumers For Quality Care, on January 9, 2020
When hospital psychiatrist Jennifer Adaeze Okwerekwu had to take her infant daughter into the hospital with a high fever and respiratory illness, she described it as one of the scariest moments of her life. As Okwerekwu writes in Stat News, the traumatic experience was made much worse when she found her insurer was unavailable during her greatest time of need.
We rushed to a pediatric emergency room where the doctors recommended that she be admitted to their hospital’s intensive care unit. Because we ended up at a hospital that was considered “out of network” by my insurance plan, I called the number on the back of my insurance card to make sure the emergency admission was OK. To my horror, the office was closed and would not re-open until Monday.
Okwerekwu was terrified that she might make a huge financial mistake by admitting her daughter to an out-of-network hospital. But even as a hospital employee and a person very familiar with billing procedures, Okwerekwu found the situation incredibly confusing and distressing to deal with in the moment.
I would have preferred to stay put and avoid any delays or complications to my baby’s care, but I knew pediatric ICU admissions were devastatingly expensive, and can cost over $3,500 each day. I used my cellphone to download and review my policy benefits, but I couldn’t think clearly enough to weed through the layers of fine print.
As a new mother, I didn’t know what to do. As a doctor, I also didn’t know what to do, because what I had been taught to do turned out to be wrong.
Okwerekwu was shocked and livid that her insurance company would take a holiday weekend off. Working holidays, she wrote, was part of the cost of working in health care. It was something she had done many times in her career.
This neglect should be illegal. In some states it is. Maryland, for example, mandates that insurance companies be available 24/7 to preauthorize care. Operating during limited business hours is bad practice. I didn’t know I had a bad insurance plan until I realized in those critical moments that I had let my baby down.