This is a chapter from my book Welcome to Hell World: Dispatches from the American Dystopia which you can order here. If you can please purchase a subscription to this newsletter.
I guess they thought I was going to kill myself. I was sitting in my doctor’s office complaining about abdominal pain and the conversation drifted to how I’d been feeling emotionally. Did you ever have thoughts about suicide the doctor asked.
Who doesn’t am I right haha I said. The doctor said she’d be right back and it dawned on me a second later what was about to happen. Ah. Shit.
The next thing I knew an ambulance and the police were there. Very good response time you have to respect that. But come on man I said. There was no way I was getting in that ambulance. I really cannot afford it. And besides if I was genuinely suicidal would I really be worried about paying a bill?
Later on after the dust had settled and I spent a little while sitting in the hospital convincing a series of very concerned doctors that I was only ambiently suicidal and not actually going to do it or am I haha I got away with the perfect crime and you’ll never catch me now I asked a bunch of people about some of the crazy things they do to avoid taking an ambulance because they’re worried they won’t be able to afford it.
I heard stories about people who had their credit permanently destroyed after a handful of ambulance rides being transferred between hospitals not fully aware of what was happening and not really in a position to object. People spoke of walking to the hospital and almost passing out along the way with severe burns or lacerations. More than a few told me about having to get into arguments with the EMTs telling them in no uncertain terms that no, they did not have to go with them. Others weren’t so adamant and regretted taking the ride when police or emergency personnel were more insistent.
“I wouldn’t take an ambulance now unless it was life-threatening,” Mike Taggart told me. A couple of years ago he was walking through a mall in Cambridge, Massachusetts when suddenly his head started ringing. Someone had thrown something off the balcony above and hit him in the head which promptly started bleeding via it being a head which is usually softer than a thrown thing.
“Someone called 911, and when they came, they were like, ‘You need to go to the hospital, and we have an ambulance,’” he said. “In my ignorance, I was like, ‘Ok.’”
The hospital they took him to was less than a mile away but when the bill showed up it was almost $2,000. “I wasn’t thinking straight at the time,” he said which checks out on account of the having his dome knocked in. “I had insurance, but the deductible was huge.”
“I always joke to my friends that if they find me dying, and they call me an ambulance, I’ll come back from the dead to fight them because it’s so expensive,” Adam Lundgren told me. “But that joke comes from a real place of fear of being stuck with a bill I can’t pay.”
He’d heard enough horror stories from friends about the costs of an ambulance over the years that when he fell down some stairs and broke his arm he said screw it and drove himself to the hospital in pain. “I’d absolutely do it again, too,” he said. “It sucks, but I feel like it’s necessary.”
One friend of mine who actually works in a hospital on the administrative side had a sudden stomach flu and asked for an ambulance. It arrived and took him a few doors down to the emergency room and it only cost $1,000. Another who is a nurse was billed $3,300 for a few miles ride and paid $1,000 out of pocket.
“I drove myself to the emergency room hemorrhaging from a surgical complication because I knew the ambulance ride wasn’t covered by my insurance,” said a third.
“Last year I was unconsciously put into one so I never paid the bill. The way I see it, I was kidnapped,” said a fourth.
Nick Johnson was on the train in Boston when it got into a crash six years ago. He hit his head on the ground and the first responders instructed him to go to the hospital so he did along with five other people.
“Five months later, I got a $900 bill that my insurance wouldn’t cover and that decimated my savings,” he said. “This for an accident that happened on public transportation and an ambulance that was shared with others.”
Uber share for ambulance something to look into maybe?
“I’ve maintained a healthy fear of ambulances ever since. I had a really bad illness last year that caused me to be briefly hospitalized. My folks told me to call 911, but scared of the cost, I walked the five to ten minutes to the hospital.”
Jon Payne blacked out after over-exerting himself at the gym a couple of years ago. An employee found him sprawled flat on his back in the bathroom. “He gave me a bottle of water and told me an ambulance was on the way. I immediately thought about the cost,” he said. He has insurance, but it’s subject to a high deductible.
“I was like, ‘Yeah, no, fuck that. I’m fine.’ I got my bearings back a few minutes later, and I left right at the same moment the ambulance was pulling up and the guys were getting the stretcher out. I walked right past them like a slick bank robber.”
Imagine that? Slinking away from the people sent to help you.
Paul Adler developed epilepsy at age twenty-six. His first seizure a few years back happened while he was at work in New York and his boss called an ambulance while he was out of it. Jesus Christ Paul has died since I wrote this originally he was a good kid and he went too soon fuck. The bill for the ride was around $1,200. Thankfully he had insurance at the time but since then when he hasn’t or has taken on new jobs and been in between insurance he makes a point to ask his co-workers not to call him an ambulance in the event something happens.
“I’ve requested that they wait until I regain consciousness and cognizance so I could get myself to a hospital in an Uber or taxi instead of shelling out another $1,200 for a ride,” he told me.
Please, everyone, I’m begging you, do not help me.
It reminds me of the shitty old Reagan joke about the scariest words you can ever hear except in this case it’s “We’re the government, and we’re here to save your life.”
One complicating factor here is that the people who come to help you aren’t always the government. In every city and state throughout the country you’ll find a wide variety of services from taxpayer-funded fire departments with EMS personnel to hospital-based services to private companies to a combination of all three and more. When it comes time to pay the bill as in all of the confounding complicated corners of our byzantine health-care system the buck often gets passed around. Knowing that some high-end insurance companies will pay the full rate while others will not or that the people being helped might not be able to afford any of it many emergency responders will charge as much as possible hoping the ones who pay full freight subsidize the rest of us.
Our municipalities know all of this too. Getting people to take fewer ambulances is something that cities around the country like Washington D.C. have been attempting to facilitate. In others like Phoenix medical taxi vouchers are offered as a means to dissuade people who might otherwise have to rely on ambulances for non-emergency medical transportation. The reasons why are pretty obvious: it frees up limited resources for more serious emergencies and it’s an acknowledgement that people are increasingly unable to pay for ambulance bills that can range anywhere from a few hundred dollars to multiple thousands of dollars.
Much of the cost has to do with the fact that ambulance companies and insurers often can’t agree on what a fair price should be and therefore ambulance companies may not contract with insurance companies so they can charge more as out-of-network providers. Complicating things further is that the mercurial nature of this billing can open the door for fraud and abuse. In 2017 Medstar Ambulance, Inc. in Massachusetts was ordered by the U.S. Attorney’s Office to pay $12.7 million in fines for inflating Medicare claims for ambulance transports.
The federal government obviously has a lot more resources to invest into making sure they’re not being erroneously billed unlike most of us who would rather pretend medical bills don’t exist until the last minute just like we do with our medical problems. Most of us don’t have the wherewithal to protect ourselves after the fact which is why the difficult choice has to be made on the fly. But perhaps that’s an idea I just stumbled on here. What if we provided the government with sufficient funds through a series of fees spread around to everyone that are then collected and distributed to administer necessary services for its citizens as needed?
In the U.K. emergency services and almost all other health-care concerns are provided free at the point-of-service. It’s not a perfect system as it can lead to abuse but it’s far better than the nightmare life-or-death game show we have here. Truly the American spirit of self-reliance at work: pull yourself up by the gurney straps.
In the meantime as ever in our hopelessly broken system of health care that may be our best hope when it comes to emergencies. Look out for yourself because no one else is going to. Even the people there to save the day. They don’t give a fuck about you.