Patient's Portion Zero

Preemie parents receive their first (expensive!) NICU hospital bill.

By Jeff Stimpson

The other day my wife Jill and I got the latest hospital bill for our baby Alex, who has been in intensive care for half a year after being born premature in June. The bill was $289,000.

So we're off to a funny start right there. About four months ago, I was talking about the bill with a nurse, and at that time I guessed that the total bill would come in at around a couple hundred thousand. The nurse rolled her eyes as if I'd tried to rent a luxury apartment using postage stamps.

"Try a million," she said. "Easy."

When you make $38,000 a year, that kind of easy means a lot of insurance. And that path wanders through the office of the primary care pediatrician we found in the US Healthcare book. The week Alex was home from the hospital, however, the ped never returned a phone call about his eating.

Then we needed referrals. Her receptionist said the office didn't have a fax machine, and only sent out mail on Thursday and Friday. But we visited two doctors last week for additional opinions and needed a referral.

It was mailed, the receptionist said, and she was sorry to hear the baby was back in the hospital. It was in fact mailed, precisely on time but a penny short on postage, and came back to the ped's office.

I've yelled into surprisingly few phones since June. But I yelled at the receptionist: She would fax the referral to doctor A, she would fax it to doctor B, and she would fax it to me!

"Why don't I just fax it to you?" she asked.

"That's unacceptable. We asked for this referral two weeks ago!"

"Please hold..."

I hung up. I called back.

"I'm having the doctor personally do it this afternoon," the receptionist said. I've been around enough doctors' offices and Times Square entrepreneurs to know what happens when somebody starts spewing the word "personally." Luckily I'm prepared to wait.

I have plenty to do in the meantime, assaulting Alex's plump rack of bills. These bills use lots of "ology" words: Cardiology. Pulmonology. Pathology. There are fancy words like "endeotracheal," and easy words like "Routine EKG." Though I do wonder if anyone who's ever needed an EKG themselves would call any kind of EKG "routine."

Just as every snowflake is different, every medical department has a bill design of its own. Cardiology, for instance, uses a border of sky-blue lines, and toward the middle of the page just a hint of rose. Infectious Disease spruces up the corner of their bill with fine logos of MasterCard and Visa, precisely printed works in miniature. Radiology uses a dash of kelly green. Optimology sends black typewriting on white paper.

My insurance company has paid well so far; of the thickening stack of "Patients' Benefits Reports" Jill and I are constantly tickled by two things. One, that the insurance company consistently takes a doctor's bill for $200, which was earned by scribbling half a line in Alex's record book ("Patient resting. Parents surly.") and bargains it to $40. "Shows you what they're time is really worth," Jill says. The second tickle comes at the bottom of the page, after all the columns and the sums and the deductions. It usually reads, "Patient's Portion: $0."

Jill and I initially had a start-of-the-school-year enthusiasm for these forms. She pre-labeled a dozen No. 10 envelopes, and we divided the load into files for "Submitted;" "Forms," "Alex," and "Paid." We vowed to fan the folders out on the living room table, VCR whirring with a rented movie, every couple of weeks.

I think we did it once in August, and filled out half a dozen bills. Then we got around to it again about Labor Day. Jill began tracking what bills had been sent to what insurance company. As the bills came to the mailbox, like chocolates coming to Lucy on the conveyor belt, I slid them into the rack.

I seem to recall we next did bills just before Halloween, and, as the Hospital volksstrum didn't come batter in our door, we next opened the folders toward the end of November. Somewhere in there, Jill had the brainstorm of photocopying almost-complete forms so all we'd have to add would be the date and signature. She also came up with the idea that we should do bills on weekend mornings.

When we fill out forms we got to it. I usually jump to fetch an insurance card or an envelope or glasses of water while Jill fills the too-small boxes with the answers to the questions:

Name, as shown on ID Card? Is patient employed? If claim is for a laboratory test, what is the nature of the illness? Is claim related to an accident? Is claim related to employment? Relationship to employee?

"How come I have to do all this?" Jill asks.

My only answer is that those who scored high on the SATs are probably better at filling out forms than people who scored low on the SATs but shined on the essay section of the Achievement Tests. "I shined on the essay section, too!" Jill says.

This kind of back-and-forth will form the backbone of Alex's personality someday. Some day when we've forgotten that he was sprung from his Neonatal Intensive Care Unit on Dec. 14 and his lungs worked for four days, and ever since he's had a plastic tube down his throat. Jill and I try to not pick at the past: the changeover of doctors in the NICU; the worry across the doctor's face as we were discharged; the papers shoveled at us that morning. The history of Alex's bad lungs seems clear to us now.

As the total ticks toward that easy million, I see that my baby will continue this fight until long after he stops being a baby. I see he and I will lose a lot, and that I'll probably hear his "Da!" between the rasps of a doctor's page. At least now, finally, Alex outweighs the file of bills. Yesterday morning we got stamps onto 13 claims; I pitched them into the mailbox on the way to see Alex yet again. I let the box lid go with a satisfying slam, and think of the questions I'd put on a form:

What could we have done differently? Will we ever stop asking ourselves that question? If they know so much, why is he still sick? What form do I use to file the most important claims of all?

Jeff Stimpson is the father of a preemie, who is eventually diagnosed as autistic. He has written several humorous and touching books about his son.