Lindsey Johnson is paying for her baby daughter’s birth, and death, on an installment plan.
At $75 a month, she will be free of the hospital bills sometime in early 2021. She would love to whip out a checkbook and cancel her debt to the Las Vegas hospital where she gave birth prematurely last April, but she doesn’t have the money. She has just one income now — she and her husband are divorcing.
“I’m going to pay it, and one day it will be gone,” said Johnson, who is 25 and lives in Boise. “The sooner it’s gone, the better. ... I just want it to go away.”
One of the facts about American health care is that you can have the worst tragedy of your life, then get billed for it. Sometimes, you also get a daily reminder from debt collectors.
Baby Stella, a micro preemie
Stella was the tiniest baby in the NICU, an intensive care unit for newborns. She weighed just over 1 pound and could fit in her mother’s hand.
She arrived four months too early, but Johnson saw Stella’s personality already emerging behind the plastic walls of her incubator. Stella would move her arms and kick. She would tug at the tubes and wires that helped keep her alive. Her eyelids were still fused shut, but her eyes moved around beneath them.
Johnson had gone into labor last year on April 22, a Sunday. At the time, Johnson and her husband lived in Las Vegas. He was in California on a work trip, and she was at home when the cramps started — then the bleeding. She drove herself to the ER at Centennial Hills Hospital in Las Vegas.
“They immediately wanted to see my insurance and wouldn’t get me into a bed or a room or anything until I had filled out the correct insurance,” Johnson said. “I had to call my husband on the phone and ask him for the information while I was having contractions.”
She thinks the hospital staff may have thought she was in “false labor.” She was only 23 weeks along.
By the time Johnson was examined, she was dilated 3 centimeters.
“They rushed me to be examined by a doctor, and they were telling me, ‘You’re in labor, and you’re going to have this baby most likely, and the outlook is not good. The likelihood of her making it is very low,’ ” Johnson said she was told. The nurses leaned her backward in bed to work against gravity while they monitored the baby, hoping to keep Stella inside as long as possible.
Stella was born at 11 a.m. the next morning, by emergency cesarean section. Johnson saw her for the first time at midnight.
“I just completely lost it and broke down,” she said. “I just looked at her, and I was like, ‘There’s no way that she can be this small and live.’ ”
NICU bill and a funeral
Tens of thousands of preemies are born each year and admitted to a NICU. The average hospital charges for a baby born at least two months early were about $280,000 for an average NICU stay of 46 days, according to a 2011 March of Dimes study.
It’s safe to assume that now, 10 years after the births included in that study, those charges are much higher.
Some premature babies, like Stella, are born on the cusp of being able to survive at all. Their hospital bills can be astronomical.
Stella was in the NICU for two days, while Johnson and her husband spent as much time as they could next to her. They weren’t thinking about how much it cost. They were trying to cherish every moment with Stella. Whenever they were in their hospital room, they worried they’d get an urgent call to go to the NICU.
“Eventually that call did come,” Johnson said. “Early in the morning on the 24th.”
The couple rushed to the NICU, and Stella’s incubator was “just surrounded with NICU nurses and doctors,” Johnson said. They were trying to revive the baby. Stella’s lungs were underdeveloped, and she couldn’t get enough oxygen. All the machines were beeping.
The doctor eventually asked, “Is it OK for us to stop trying to resuscitate her?” Johnson said yes.
The couple was ushered into another room, and the medical staff brought in Stella’s body. It was the first time Johnson got to hold her.
“I vaguely remember someone coming in and talking about finances with me. I don’t remember if that was when she was in there, or before they brought her in to me,” Johnson said. “Somebody briefly mentioned financial counseling and advising, but at that time a medical bill was not even close to being on my mind at all. And it wouldn’t manifest itself fully until months later, with the debt of just those few days.”
The hospital bill for the NICU was about $80,000.
Labor and delivery were billed separately. Johnson doesn’t remember how much they amounted to, but the national average charge for just a C-section in 2015 was $25,107, according to the federal Agency for Healthcare Research and Quality.
After insurance, the total out-of-pocket costs for Stella’s birth and death were about $7,000.
“We had a funeral to plan,” Johnson said. “So we went home that day. And leaving the hospital without her was just the worst thing imaginable.”
A friend put together a GoFundMe for the family. It raised enough to help pay for Stella’s funeral, other bills and the cost of moving away from Las Vegas and the painful memories it held. (The GoFundMe campaign is still active as Johnson continues to pay off the debt.)
Johnson and her husband came to Boise, where Johnson started a job as communications director for the Idaho Democratic Party. The move was so soon after Stella’s death that Johnson couldn’t help lift boxes; she was still recovering from the C-section.
But the medical bills were just getting started.
The debt collectors call, but she can’t pay
Johnson says she gets calls from Ohio, Missouri and other parts of the country, all day every day. One afternoon earlier this month, she looked at her missed calls from medical debt collectors:
- 8 a.m.
- 9:08 a.m.
- 9:32 a.m.
- 10:22 a.m.
- 10:56 a.m.
- 11:13 a.m.
They’d called four times the day before.
The federal law governing debt collectors sets some limits on their phone calls. For example, they can’t call someone over and over again in an attempt to harass them into paying debts. They can’t call before 8 a.m. or after 9 p.m. And they have to provide information about the debt up front, then prove its validity if a person disputes it.
Johnson said she isn’t sure what bills are in collections. She lost track. She can’t afford to pay anything else, she said, so she doesn’t answer the calls.
She knows she still owes the hospital about $1,600 for her labor and delivery. That’s what she’s paying off at $75 a month.
Patients like Johnson don’t get one bill for ‘going to the hospital to deliver a baby who lives for two days in the NICU.’ There are separate bills from the hospital, the anesthesiologist, laboratories, ER doctors and others. There are separate bills for each patient, too.
Some of the bills Johnson and her husband got were addressed to Stella.
How St. Luke’s handles sensitive cases
The Nevada health system that owns the hospital where Stella was born said the bills may have been coming from other providers, too.
“Our deepest sympathy is with the family on the loss of their baby,” Valley Health System Director of PR and Media Relations Gretchen Papez said in an email. “Losing a loved one, especially a child, is heartbreaking, and we do our best to help families navigate through this difficult time. While a financial conversation may begin in the hospital, we encourage patients to contact the billing department to discuss private financial matters and determine what options are available.”
St. Luke’s Health System, based in Boise, delivers more than 7,000 babies a year — about a third of all the babies born in Idaho. Its staff is trained to handle situations like Johnson’s “with extreme sensitivity to the families,” spokeswoman Anita Kissee told the Statesman.
St. Luke’s first looks to the insurance company to pay the bill. Then, if a balance is left for the patient or family, St. Luke’s can offer financial assistance, she said.
“In the case of children, our accounts are all registered with the mother as the guarantor to ensure any bill is not sent directly to the baby,” Kissee said. “In the case of an adult, any correspondence would be directed to the estate of the patient. After one month, the name would be changed to that of the spouse.”
One “particularly compassionate person” has the specific job of handling sensitive cases like a child loss, Kissee said.
“She shared that she finds real fulfillment in helping these families through a difficult time by providing them with solutions to any balance that may be due,” Kissee said. “She handles these situations by always placing herself in the family’s shoes and supporting them in the way she personally would want to be supported.”
That employee’s boss is Dana Thomas, revenue cycle supervisor for the St. Luke’s patient financial services office. Thomas told the Statesman that it’s rare but does happen that a parent is faced with hospital bills for a baby or child who died. (State vital statistics say 162 babies in Idaho were stillborn or died in their first week of life in 2017, the most recent year available.) Her team tries to guide the parent through the process, so they’re not left trying to figure it out on their own, she said.
“I really do find it fulfilling to help a family resolve that part, because that can be confusing and difficult,” she said. “They’re not always in that frame of mind to make that easy.”
Hospital billing and the illusion of a set price
For the past year, Johnson had been paying $162 a month toward her hospital bill. After she and her husband filed for divorce, she called the hospital’s billing department to ask for a lower monthly payment. He has helped, and continues to help, pay down the medical debt, but their divorce meant splitting into two households with two sets of expenses.
The man on the phone offered to “make it all go away” if she paid $1,100 right then, Johnson said.
“Well, I don’t have $1,100, so I can’t do that,” she told him. “I just want to reduce my payment to $50.”
He gave her a counteroffer: $75 a month. Johnson said OK.
“Just so you know,” he told her then, according to Johnson, “you qualify for $850 if you pay it all at once.”
As a patient, Johnson said the doctors and nurses were kind. One nurse even walked her out after she was discharged, hugged her and cried with her. But the business side? That phone call? Totally different story, she said.
“The thing that frustrates me is thinking about the families that go into debt over medical bills, and that there’s people who just, with the snap of a finger, could reduce it — just because,” she said. “And there’s people who suffer so immensely from these bills that are just the (dollar amount) they are for no reason,” she said.
Johnson said she knows that people working in health care need to get paid, and it costs money to run a hospital. But the experience left her feeling like the payment plans, the settlement offers, the debt collection calls — that they’re part of a game to get as much money as possible from people who recently experienced injury, illness or trauma.
“The reality of it is, even though it is technically doable to pay all of this, I was not in a position mentally or emotionally to sit down and look at all the bills, and make calls to the hospital (and doctors) and all the billing departments,” Johnson said. “The thought of doing that was impossible to me.”
Editor’s note: A sentence was added to clarify Johnson’s ex-husband’s contributions toward paying medical bills.