At the emergency room of Long Island College Hospital, Andrew Ondrejcak explained the nature of his stomach pain to an intern. Notes were taken. The intern vanished. This happened three times in five hours. At 7 a.m., nearly seven hours after he arrived, Ondrejcak was given a CT scan. “Within fifteen minutes of getting the results back, I was on the operating table, opened up,” he said. “Apparently, my appendix was about to rupture.”
What took so long? Appendicitis is among the easiest conditions to diagnose: A CT scan will detect it 90 percent of the time, and appendectomies are among the most common surgeries performed. But CT scans are expensive, and doctors, when dealing with the uninsured, are hyperconscious of burdening both patient and hospital with undue expenses. According to a report by the Institute of Medicine, the uninsured are far more likely to receive inadequate care in hospitals: Conditions are improperly managed; most bleakly, the uninsured are more likely to die in hospitals than the insured. “It’s those catastrophe situations where insurance really proves invaluable,” says the United Hospital Fund’s James Tallon. “Without insurance, you’re likely going to run into a roadblock at every stage of the process. Will you get a referral? Will you get the right tests? What kind of care are you going to get?”
After Ondrejcak came out of surgery, his mother arrived from Mississippi and noticed something the nurses had somehow overlooked: Her son was sweating profusely, yet his skin was cold to the touch, and a rash had broken out over most of his upper body. “My mom is typically this very sweet southern woman, but she was so pissed off,” he recalled. “She asked if I was getting negligent care because I didn’t have insurance. Later, the doctor made some remark about how the hospital is ‘careful’ with cases like mine because most people never pay.” It turned out that Ondrejcak was having an allergic reaction to the antibiotics, so he was taken off the medicine. The rash subsided, but the healing process was jeopardized. The following night he was discharged, only to find himself in serious pain again four days later—a condition the surgeon initially diagnosed as the result of an “idle mind.” “He said I’d been sitting around all day, and that sometimes your mind can believe things are happening that aren’t really happening,” remembered Ondrejcak. “I couldn’t believe it.”
When his test results came back, the doctor’s tone was more urgent. Ondrejcak’s white-blood-cell count was three times normal, his pain likely connected to an internal infection and not at all imagined. He was ordered to come to the hospital “immediately,” a term that has a different meaning to the uninsured. Once again, Ondrejcak had to be admitted via the emergency room, wait a few hours, then explain to the ER physician that his doctor had sent him, wait while they paged the doctor, and again before being admitted. He spent the next three days in the hospital, getting injections of intensive antibiotics every eight hours.
At last, he started to heal properly. Three weeks later, the only evidence of the ordeal was a two-inch-long burgundy-colored scar below his right hipbone.
“And then,” said Ondrejcak, “I got the bills.”
They came separately, over the course of a week. The most damaging expenses were for his overnight stays: $16,608.76 for his first, $16,223.61 for the second. Then came the surgeon’s bill ($1,665.50), the anesthesiologist’s ($1,014), the two ER physicians ($605), the blood clinic ($551), and the post-op clinic ($592.04). A staggering $37,259.91 in total, a sum far higher than the prenegotiated rates the hospital would have charged an insurer. “That’s one of the unfortunate ironies,” says Cunningham. “The same people who don’t have insurance because they can’t afford it are charged much higher rates than someone with insurance.”
Panicking, Ondrejcak called the hospital. “Look, I have no money,” he told the woman from billing. “What am I supposed to do?”