As my father got older, I began to dread getting the phone call, the one in the middle of the night from a neighbor or nurse that announced he had fallen or died suddenly, or worst of all, been found lying on the floor of his house for some unknown number of hours….
When the phone call came, though, it was not in the middle of the night but in the middle of an ordinary Monday afternoon and the news was not what I had necessarily predicted: it was a nurse calling from a hospital in upstate New York to tell me that my father, 84, had been in a car crash.
I live in New York City ,and yet I am the closest family member to my father geographically. I have sisters in France and Oregon, and my father has no other living relatives. He spent his retirement painting full time in a small town on the Hudson. It was his dream, and he had the good health and, barely, the financial resources to sustain that life for 20 years. He lived in a huge Victorian house, and, while my sisters and I knew this idyll wouldn’t last forever, my father refused to move. Now the expected crisis had arrived.
As it turned out, the car crash was the least of my father’s medical problems. He had broken a vertebra in his neck and was consigned to a neck brace for six weeks, but a CAT scan had revealed a brain tumor, which had probably caused the car accident by affecting his vision.
There had been no signs of any mental confusion in the weeks before, and indeed it turned out to be a particularly aggressive form of brain cancer: glioblastoma multiforme (or GBM). On that first Monday in May my father was taken by ambulance to the nearest hospital, then by helicopter to the nearest regional trauma unit.
Over the course of the next two months he was moved many times: from trauma ICU to trauma ward, from surgical ICU to surgical ward, and finally to a nearby hospice for the last week of his life. He had left his house to do some local grocery shopping and never went home again.
The rest of this personal story of illness and loss may not matter to anyone but me, my sisters, and my father’s devoted friends and neighbors, who visited throughout the long ordeal. He had good days and bad days, and we had tough decisions to make about choosing the brain biopsy (yes), radiation therapy (yes) and then life sustaining measures when he was clearly failing (no).
For this website, though, I will focus on the financial trauma of all this. My father lived on a very tight budget, but the value of his house made him ineligible for Medicaid. For years he had received excellent medical care from the local Veterans Administration hospital as a veteran of World War II.
However, the medevac had transported him to a different private hospital….what was going to happen to all of these bills? Would Medicare cover them? Would the VA? My father had no private “medi-gap” coverage, so we just filled out forms and held our breaths, waiting for the first bills.
The first was for the medevac transportation: $24,000 for the twelve-minute helicopter ride. Yes, that’s $2,000/minute. What struck me first, besides astonishment at the numbers, was that we had no chance whatsoever to approve or allow this expense – it was decided upon without any input from family. While I understand all emergency measures cannot be discussed in advance (and I am not equipped to decide if a head injury can tolerate transportation by car) this seemed to signal the rest of our experience with the medical establishment: at no point were the costs of treatment considered by doctors or even provided to family members. It’s easy to see why that is so: as I said above there are questions of timeliness and expertise and also questions of ethics. You wouldn’t want different patients receiving different care based on their ability to pay or the willingness of relatives to approve it (although of course this happens anyway). As it turns out this bill from the air transportation company could be forwarded directly to New York State’s no-fault automobile insurance plan, which covers the first $50,000 of all automobile-related medical costs. At this rate, however, that plan would cover about twenty-five minutes of my father’s first day in the hospital.
(Please note that insurance information is only based on my own knowledge and cannot be considered authoritative!)
Next: The V.A. experience