ER visits amount to big health care bills for uninsured

The (Raleigh) News & ObserverNovember 2, 2009 

Editor's note: This fall, The Raleigh News & Observer is talking to people about the nation's health care system: what works, what doesn't and what should be done to fix it.

With her diabetes, high blood pressure and cholesterol under control, Gail Johnson expects to be around to see her grandchildren grow up. But the 56-year-old figures she'll die long before she's able to pay off her hospital bills.

"I don't even know how much I owe WakeMed. That's how bad it is," she says, guessing it's well over $20,000.

Johnson amassed that debt doing what uninsured Americans do millions of times each year when they get sick: Go to a hospital emergency room.

Emergency rooms have become the U.S. health care system's safety net, where anyone can go for treatment and no one can be turned away because they can't pay in advance.

But experts say using emergency care in place of checkups and doctor visits is the most expensive way to deal with chronic illness. Many of the 119.2 million emergency visits racked up in 2006 were for problems that could have been prevented through regular primary care. More than 17 percent of those visits — nearly 21 million — were made by patients who had no insurance, according to the National Center for Health Statistics.

The average emergency room bill is about $1,300; much more if the patient is admitted. A visit to a doctor's office starts around $75.

But hospitals are required to take patients who have no insurance and no ability to pay; they bill later and hope to collect. Doctors' offices require proof of insurance or payment at the time of service.

Johnson's was a typical case.

During her 27-year marriage, she says, she was insured through her husband's policy at work. When they split up more than a decade ago, she lost her coverage. She found work, but never with benefits.

So she went years without going to a doctor, a dentist or an ophthalmologist. She didn't realize her blood sugar was out of whack, and her blood pressure and cholesterol were rising. The first time she went to the WakeMed emergency room, she had a major kidney infection and severe dehydration.

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