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On Thanksgiving evening my baby spiked a high fever. By Friday morning her little head started bobbing up and down as it became hard for her to breathe. My daughter had an infection and she was in respiratory distress.

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. 


Exhausted by illness and overwhelmed by her medical care, my daughter became momentarily unresponsive to my voice and my touch. This was one of the scariest moments of my life, and it was made even more devastating by the specter of a medico-financial misstep. 

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.


I knew better than to consent to treatment without asking questions first.

As a medical student at the University of Virginia, I remember encouraging my ER patients to accept the hospitalizations that they needed. When they, too, worried about the cost of care, I parroted a line I’d learned from residents and attendings throughout my training: “Don’t worry, the financial office will help you with that.”

But for these patients there was no help. After accepting care from UVA, the hospital system billed patients like mine and then sued them for an inability to pay, seizing the homes of some and bankrupting others. 

Aiming to avoid a financial trauma of my own, I knew better than to consent to treatment without asking questions first. 

When a patient representative showed up to our ER bay to let me know that my “insurance was verified,” I pressed her to clarify what that meant. Would I be billed for this admission? She didn’t know. No one did: not the billing office, nurses, case manager, pediatric ER fellow, or attending physician. 

All of them recommended that I call the number on the back of my insurance card for the definitive answer.

I’m livid that my insurance company was closed for the holiday weekend, and that it even closes at all. As the psychiatrist on call for my hospital, I worked the holiday, spending my daughter’s first Thanksgiving away from her and my family.

Working holidays, nights, and weekends is the cost of working in health care — a cost that many insurance companies are neglecting to pay. As I’ve written before, I’ve seen these irresponsible insurance practices impact my patients and now they were impacting my family. 

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. 

When she was stable enough, an EMS crew strapped my baby onto an oversized stretcher and loaded her onto an ambulance. I prayed that she would be all right en route to the next “in network” hospital. I hoped that it wasn’t a risk we took for no reason at all. 

Update: After a week in the hospital, my daughter is recovered and back being her sweet and playful self.

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