Emily Articulated: Emergency math

By Emily Erickson
Reader Columnist

I was at mile 17 of my 26-mile mountain marathon when the straps on the backpack started to feel like they were chafing. By the 18th mile, the chafing escalated into itching and burning, with angry hives spreading from my back to my stomach, and across my arm. By mile 19, I was breathing fast and shallow. I was having an allergic reaction, made more intense by being in the middle of a race. Luckily, I’ve been trail running too long not to carry Benadryl with me whenever I go, which I gulped down at the direction of aid station volunteers. Ten minutes later, I was driven off the course and deposited into an ambulance, an oxygen mask strapped to my face while I waited for the paramedics to arrive.

Emily Erickson.

By the time a second ambulance pulled beside ours, the Benedryl I had taken had fully kicked in. My breathing was back to normal, and my hives had faded from angry welts to dull, achy splotches. My family, who was at the venue to spectate, stood separated from me by the big, square doors of the vehicle. The medic explained, “She’s fine now, but there’s a chance the reaction could flair up again, so we’re taking her to the hospital.” 

Immediately, my stomach clenched. I knew ambulance rides were expensive, as were emergency room visits, and, in my restored state, it felt unnecessary. But, it also seemed like I didn’t have a choice — not just that refusing care might be irresponsible, but that it was an option at all. As they closed the doors, I was separated from my advocates, and the ambulance started to drive. Suddenly, it felt like I was tossed into the spin-cycle of health care, about to be tumble-dried before I could be declared, “good as new.”

At the ER, I was administered precautionary antihistamines along with a bag of saline. While the IV was still in my arm, an office administrator came into the room and confirmed my Social Security number, solidifying that the financial repercussions of my visit would be as firmly attached to me as the needle currently under my skin.

The next morning, while shaking off the grogginess of Benadryl-deepened sleep, I checked my insurance plan coverage. My in-network deductible is $9,000, with a max out-of-pocket payment capping at $8,200. Fifty percent of ambulance and emergency services are covered, but only after I reach my deductible. This plan, which won’t start helping me with emergency expenses until I spend $9,000 (or $17,000 for out-of-network services), costs me $400 a month — a bill I’d been dutifully paying for two years. It was like a bad math equation.

Now, fully entrenched in the numbers, I began tallying up my prospective bill. A quick Google search revealed that the average cost of an ambulance ride has risen from $900 in 2017 to $1,500 in 2023, with additional factors like services rendered, distance traveled, personnel attending and medications administered driving up the cost by hundreds, if not thousands, of dollars. As for ER costs, they begin as soon as you’re registered with a triage fee, typically ranging from $200-$1,000. 

Then, once you’re assigned to a room, you incur a facility charge of around $1,000. This does not include physician fees, medication or supplies used during a visit. I realized, with sinking clarity, that my day in the mountains would cost me somewhere between $4,000-$8,000, despite having an insurance plan that had cost me $9,600 in the past two years.

And, the worst part of the equation? I had to count myself fortunate. I was OK. I received good care, with a good outcome. And with a payment plan, the bill won’t financially break me. But for so many others swept up in our health care system, receiving life-saving services comes at the cost of crippling, life-altering debt. 

In a study by the Census Bureau, approximately 16 million people owe more than $1,000 in medical debt, with 3 million of those people owing more than $10,000. In 2022, 14% of people with medical debt plan on declaring bankruptcy to absolve themselves of it.

In a country with some of the best medical services in the world, people are routinely forced to ask themselves if they can live with the cost of being saved. Even when they play by the rules, paying expensive premiums on insurance plans, they can fall through the cracks into unimaginable circumstances — with repercussions that ripple out beyond themselves, into the people they support and the people who care for them.

It all prompts the questions, “How did we get here?”; “What do we do about it?”; and, “If the cost of good care is X, and the impact on your life is Y, what choice are you left with?” Now, that is an equation begging to be solved.