A patient is angry with her emergency care bill. But here’s what she really got.


Natalie Fuelner created a well-written article in the Bangor Daily News describing some of the tribulations many new parents go through with young children. One weekend, her toddler fell face first onto a metal patio table. Immediately, the toddler’s face is full of blood. The dad panicked. Natalie was a “trembling mess” on the inside.
Their physician neighbor wasn’t available to look at the child. They didn’t want to wait two and a half hours at the urgent care center. They were both still panicking, so they went to the emergency department where they were evaluated immediately by an emergency nurse and then 10 minutes later by an emergency physician. The emergency physician evaluated the child, determined that putting stitches into the laceration on the child’s lip would be more traumatizing than letting the laceration close on its own, and then gave the child a popsicle.

Wait? That’s it?

Suddenly their panic was gone. Then they felt embarrassment.

A couple of weeks later they received a $514 bill for the services and Ms. Fuelner quipped “That was one pricey popsicle.”

One innuendo from the article seems to be along the lines of a comic I once saw from Bob Vojtko. An elderly woman was pointing her finger at a doctor saying, “I spent $4 in cab fare to get here, so you better find something wrong with me.” Another underlying theme in the article is that many people don’t realize the costs of providing medical care in this country.

I absolutely agree that $500 is a lot of money. And based on Ms. Fuelner’s perceptions, some people may think that she got “ripped off” for the services she received. Unfortunately, in the world of $20 copays and government-mandated free birth control pills, there seems to be a pervasive belief that medical care should cost less than an appointment at a hairstylist and should definitely cost less than the newest iPhone.

Let’s look at what Ms. Fuelner got for her $500.

She got the convenience of immediate access to a large business providing services to the public that is open every minute of every day. That business has millions of dollars of overhead costs every year that it must pay just so that it can keep its doors open. She got immediate access to expertise from a nurse who spent tens of thousands of dollars to go through years of post-graduate training and who gave up her weekend so that she could be there to care for sick and injured patients.

She also got immediate access to a physician who spent hundreds of thousands of dollars and went through even more post-graduate training, and who also gave up his weekend so that he could be there to help sick and injured patients. Those are just the two medical professionals who cared for her child. I’m sure there were many more available in the department. I could go on and on about all of the hard-working personnel in the hospital whose services are available and who contribute behind the scenes to many patient visits — radiology, lab, surgical personnel, registration clerks, billing department, housekeeping, maintenance, cafeteria, security, IT, and many others — even administration, but hopefully you get the point.

The hospital also has advanced diagnostic equipment costing millions of dollars — available and waiting if Ms. Fuelner’s child happened to have hit her head and had brain bleeding, knocked a tooth out and inhaled it into her lung, suffered a neck injury, had eye trauma, or suffered some other injury from her fall. Fortunately, that wasn’t the case.

Federal law also requires that the hospital provide a screening exam and stabilizing treatment to any patient who is seeking medical care — regardless of the ability to pay. I’m sure that some of Ms. Fuelner’s $500 went to defray the costs of many others who receive care but who either cannot afford to pay or whose insurance pays for less than the cost of care.

Most of all, Ms. Fuelner and her husband received peace of mind for her $500. Her daughter was evaluated by a medical professional who considered all of the possible injuries and determined that she had not suffered any serious injuries. When patients tell me that they feel embarrassed for coming to the hospital, I stop them mid-sentence. Don’t. It is always better to be safe than sorry. Consider what would have happened if you had not sought out medical care. You would have been up all night worrying and searching the internet on Dr. Google trying to figure out about what to do for a laceration on a child’s lip, then you probably still would have sought out medical care the next day.

So, no Ms. Fuelner, you didn’t pay $500 for an emergency popsicle. The $500 you paid went to help cover some of the immense costs involved in being able to provide quality medical care to you and your family at any hour of any day and it went to the peace of mind that you and your husband experienced when the doctor examined your child and told you that everything would be OK.

The popsicle: That was free.

“WhiteCoat” is an emergency physician who blogs at WhiteCoat’s Call Room at Emergency Physicians Monthly and Dr. Whitecoat.

Image credit: Shutterstock.com


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