美国国家公共电台 NPR First Came Kidney Failure. Then There Was The $540,842 Bill For Dialysis

 

NOEL KING, HOST:

All right, we're going to talk today about our medical bill of the month for the month of July. We have seen some pretty outrageous¹ bills sent in by our listeners, but this is the biggest one we've seen yet.

Dr. Elisabeth Rosenthal is the editor-in-chief of our partner Kaiser Health News, and she's in the studio to tell us about it. Hi, Elisabeth.

ELISABETH ROSENTHAL, BYLINE²: Good to be here. Yes, this one's a doozy.

KING: This month's bill went to a couple in the state of Montana.

ROSENTHAL: Yeah, this month, we meet Jessica and Sov Valentine. They've run into what can happen to you when you have to go out-of-network for kidney dialysis or any other procedure, frankly³.

KING: So being in and out of network can be confusing for a lot of people. It was in this case. We sent reporter Nick Mott to visit the Valentines in their home in Plains, Mont.

NICK MOTT, BYLINE: Sov Valentine is in his garage-turned-gym doing some leg extensions. He's been a personal trainer for three decades. But right now, he's skinny as a rail.

SOV VALENTINE: When I first got sick, I - honestly, I was laying in bed with a two-pound dumbbell.

MOTT: He says he's doing everything he can to stay strong and fit so he can be ready for a kidney transplant when the time comes.

VALENTINE: After all these years, I know that if you don't maintain what you have, even if it's just doing two pounds, you're in trouble.

VALENTINE: Back in January, he'd been feeling weak and fatigued⁴ during his workouts. Then one day, he started vomiting⁵. He knew something was seriously wrong, and he went to the hospital. But Plains, Mont. is a small town. And there was only one physician working when he got there. It was his wife, Jessica.

JESSICA VALENTINE: He just showed up at the front desk, so...

MOTT: What were you thinking?

VALENTINE: Oh, shoot.

MOTT: His kidneys were covered in cysts, and they were barely functioning. He'd need to start dialysis immediately.

VALENTINE: It's just shock. I mean, there's no other way to describe it.

MOTT: He's 50, really young for such a major health issue. It's a lot to deal with.

VALENTINE: What I do is just focus on what the one task is, whether it's big or small. Get through that, and don't worry about anything else.

MOTT: While Sov took it one day at a time, Jessica started doing the dirty work of figuring out what all this was going to cost.

VALENTINE: So I am pretty familiar with navigating⁷ the system because I have to do it for my work all the time. So I call insurance companies and try to get things authorized⁸ for patients as part of my job.

MOTT: Their insurance company said all the dialysis options in Montana were out-of-network. So Jessica called Fresenius, a dialysis center. The center said they couldn't give them an estimate and referred them back to their insurance, who referred them back to Fresenius and on and on.

Sov started treatments three times a week at Fresenius. As the time passed, the Valentines held their breath.

VALENTINE: While the bills were adding up, we didn't have any idea what the bills might be. So we didn't get any bills until he was essentially⁹ almost done at Fresenius.

MOTT: The first bill came in late March after 2 1/2 months of treatment. It was for $120,000. Jessica called Fresenius immediately. After several phone calls, all she found out is that they might be eligible¹⁰ for financial aid.

VALENTINE: That is ridiculous. I don't know who would be able to possibly do that. It's crazy.

MOTT: Then more bills came. That number grew to more than half a million dollars. They received a collection notice, too.

VALENTINE: It just doesn't seem real.

MOTT: Sov keeps taking things one step at a time. They kept digging and eventually found an in-network dialysis center at a fraction of the cost. They applied¹¹ for financial aid from Fresenius and Medicare. The stress of being sick, of owing so much money, it compounds.

VALENTINE: I'm focusing on keeping my energy to heal. You know, I'm headed for a transplant. And I don't want to wear myself out, which is what this does.

MOTT: Sov's wife is a doctor, and he has good insurance. But he says he knows not everyone has the same luck.

KING: That was Nick Mott with Montana Public Radio. OK, Elizabeth, so Sov told Nick that he feels lucky. But he still has a half a million dollar bill that he's got to pay. Will Fresenius negotiate with him at all?

ROSENTHAL: Well, the company did come back to the Valentines and offered to cut it by 50%. But, you know, that's still more than Jessica owes in student loans for med school and, frankly, more than many kidney transplants would cost.

KING: This couple in Montana are not the only people in this country having problems with the cost of dialysis. The federal government has actually started paying attention to this, right?

ROSENTHAL: Yeah, I mean, dialysis has gotten some headlines because the Trump¹² administration wants to make some changes that could result in taxpayers¹³ saving some money on dialysis care. It's mostly a cost to the federal government. And that's because the vast majority of people who need dialysis, people who develop end-stage renal disease like Sov, can get on Medicare under a 1973 bill.

But there's a catch to that, and they have to wait 90 days until they qualify. And that's where Sov gets really stuck.

KING: And once you're on Medicare, how much does it pay?

ROSENTHAL: Well, here's the crazy thing. Medicare pays about $235 per dialysis session. Meanwhile, Fresenius charged Sov $14,000 a session - huge gap there. And remember; end-stage renal disease is life-threatening. When you need dialysis, you need it, and you need dialysis three times a week.

KING: Could he have gone someplace other than Fresenius?

ROSENTHAL: Well, there aren't a lot of options. Fresenius and one other company, DaVita, control about 70% of the dialysis market in the U.S. And since Medicare picks up the tab after that 90-day wait, the companies play hardball with insurers for patients who have private insurance. It looks like they're simply trying to charge whatever they think they can get away with.

KING: So it sounds like what you're saying is there was not much they could have done to prevent this bill.

ROSENTHAL: Well, they were told there were no in-network options. He needed immediate⁶ dialysis. And when Jessica checked, that appeared to be the case. If there's no way to stay in network for needed care, under some state laws that could be considered a surprise bill, so fight it.

Also, President Trump's announcement earlier this month could have offered some help in that it's promoting alternative types of dialysis that can be done at home. But for now, the Valentines are in a tough position.

KING: So what's their plan? How are they doing now?

ROSENTHAL: Well, after discovering that there was an in-network provider in state that hadn't turned up in the directory, Sov is getting his dialysis there now. And pretty soon, he'll be eligible for Medicare. But what he's really hoping for is to get a kidney transplant soon.

Also, sadly, this hardworking couple is considering filing for bankruptcy¹⁴ if they have to pay that bill.

KING: Dr. Elisabeth Rosenthal from Kaiser Health News, thanks so much for being here.

ROSENTHAL: Absolutely.

(SOUNDBITE OF MUSIC)

KING: If you have a baffling or surprising medical bill that you want us to take a look at, go to NPR's Shots blog and tell us all about it.

1 outrageous   

adj.无理的，令人不能容忍的

参考例句：

• Her outrageous behaviour at the party offended everyone.她在聚会上的无礼行为触怒了每一个人。
• Charges for local telephone calls are particularly outrageous.本地电话资费贵得出奇。

2 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

3 frankly   

adv.坦白地，直率地；坦率地说

参考例句：

• To speak frankly, I don't like the idea at all.老实说，我一点也不赞成这个主意。
• Frankly speaking, I'm not opposed to reform.坦率地说，我不反对改革。

4 fatigued   

adj. 疲乏的

参考例句：

• The exercises fatigued her. 操练使她感到很疲乏。
• The President smiled, with fatigued tolerance for a minor person's naivety. 总统笑了笑，疲惫地表现出对一个下级人员的天真想法的宽容。

5 vomiting   

吐

参考例句：

• Symptoms include diarrhoea and vomiting. 症状有腹泻和呕吐。
• Especially when I feel seasick, I can't stand watching someone else vomiting." 尤其晕船的时候，看不得人家呕。”

6 immediate   

adj.立即的；直接的，最接近的；紧靠的

参考例句：

• His immediate neighbours felt it their duty to call.他的近邻认为他们有责任去拜访。
• We declared ourselves for the immediate convocation of the meeting.我们主张立即召开这个会议。

7 navigating   

v.给（船舶、飞机等）引航，导航( navigate的现在分词 )；（从海上、空中等）横越；横渡；飞跃

参考例句：

• These can also be very useful when navigating time-based documents, such as video and audio. 它对于和时间有关的文档非常有用，比如视频和音频文档。 来自About Face 3交互设计精髓
• Vehicles slowed to a crawl on city roads, navigating slushy snow. 汽车在市区路上行驶缓慢，穿越泥泞的雪地。 来自互联网

8 authorized   

a.委任的，许可的

参考例句：

• An administrative order is valid if authorized by a statute.如果一个行政命令得到一个法规的认可那么这个命令就是有效的。

9 essentially   

adv.本质上，实质上，基本上

参考例句：

• Really great men are essentially modest.真正的伟人大都很谦虚。
• She is an essentially selfish person.她本质上是个自私自利的人。

10 eligible   

adj.有条件被选中的；(尤指婚姻等)合适(意)的

参考例句：

• He is an eligible young man.他是一个合格的年轻人。
• Helen married an eligible bachelor.海伦嫁给了一个中意的单身汉。

11 applied   

adj.应用的；v.应用，适用

参考例句：

• She plans to take a course in applied linguistics.她打算学习应用语言学课程。
• This cream is best applied to the face at night.这种乳霜最好晚上擦脸用。

12 trump   

n.王牌，法宝；v.打出王牌，吹喇叭

参考例句：

• He was never able to trump up the courage to have a showdown.他始终鼓不起勇气摊牌。
• The coach saved his star player for a trump card.教练保留他的明星选手，作为他的王牌。

13 taxpayers   

纳税人，纳税的机构( taxpayer的名词复数 )

参考例句：

• Finance for education comes from taxpayers. 教育经费来自纳税人。
• She was declaiming against the waste of the taxpayers' money. 她慷慨陈词猛烈抨击对纳税人金钱的浪费。

14 bankruptcy   

n.破产；无偿付能力

参考例句：

• You will have to pull in if you want to escape bankruptcy.如果你想避免破产，就必须节省开支。
• His firm is just on thin ice of bankruptcy.他的商号正面临破产的危险。