Taken to the hospital against her will — who pays the bill?

Sue Burgess began to feel sick on a Southwest Airlines flight from Phoenix to Albuquerque earlier this year, and after a rough trip in which she filled several barf bags, she was sent to a hospital after the plane landed. She’s fine now — turns out she had the stomach flu — but there’s the small matter of a $9,000 hospital bill.

Her insurance took care of the bulk of it, leaving her with a $392 tab. She thinks Southwest should cover the balance, since she never asked to go to the hospital. The airline had called the ambulance, after all.

Who should pay?

Here’s how Burgess remembers it:

When I got off the flight, I was dehydrated and I fell going up the ramp. I asked the flight attendants if there was any place I could lay down. While I was not at my best, I never lost consciousness and I was perfectly capable of carrying on a conversation.

The flight attendants immediately called the paramedics who began to fire questions at me. At no time was I offered the choice of calling a friend to pick me up or any option other than being taken to the emergency room in an ambulance. Once I got to the emergency room, I was told I couldn’t leave because it would be against medical advice and the hospital would not submit my bills to the insurance.

Shouldn’t Southwest or the paramedics offerred me the choice to call a friend? Don’t people who get sick on planes have any rights?

They certainly do.

The Southwest flight attendants who called paramedics were likely following their training. At the time, no one knew what was wrong with Burgess, and their actions could have saved her life.

Still, I thought it was worth running her problem past Southwest. The airline hadn’t bothered responding to her request for reimbursement, which is not at all like Southwest.

Here’s what she received from an attorney representing the airline.

Southwest Airlines flight attendants state that upon exiting the aircraft you lost consciousness, vomited, seemed lethargic and requested a place to lie down.

The Southwest Airlines flight attendants promptly called paramedics to assist you. Apparently, after assessing your condition, the paramedics decided to take you to a nearby emergency room for treatment. The Southwest Airlines flight attendants who came to your aid when you were ill have no control over the actions of the paramedics who assessed your condition and made the decision to take you to a hospital.

We do not believe this is a case of liability against Southwest Airlines nor does Southwest carry a medical pay provision in their policy. We must respectfully decline to make payment on your claim.

I asked Burgess what she thought of the answer.

There are a couple of statements in her letter that are untrue. I did not vomit or lose consciousness after leaving the plane. I suppose I was lethargic, being dehydrated, and I did ask for a place to lay down.

What’s significant in my experience with Southwest is that the flight attendants totally ignored me during the flight and I used up all my energy carrying those damn barf bags to the back of the plane.

Burgess missed a business meeting, depriving her of $8,000 in revenue as a result of the overnight stay in the hospital. She thinks the least Southwest can do is pay her deductible.

Who’s right? I can certainly see both sides in this dispute. I wonder what kind of precedent would be set if the person who called an ambulance were responsible for the entire hospital bill.

What do you think? Did Southwest do everything it could to help Burgess? Or could it have done more?

(Photo: bryk mantra/Flickr Creative Commons)

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  • barbie45

    Carver,and others. Illegal aliens come in all races,colors,shapes,sizes. Who knows maybe some are Martians. It is to bad that the major theme of the original post has gotten off track.

  • Lisa S

    @Emergency Room Resident: I suspect you are not the person who had to pay for x-rays done so poorly in the ER after an accident that they had to be re-done at additional expense to the patient (namely me). I didn’t mind the x-rays being done–I minded them being done poorly and being charged for them, and then being told the bill would be sent to collections if I didn’t pay it (and I am shortening the story and not including the problems with insurance companies). I suspect you are not the doctor who ordered a bunch of labs that were unnecessary had the attending doctor (who I never wanted to talk with but who was foisted on me by the hospital; a number of people have complained about him but to no avail) who was either trying to enhance his RVUs (because as far as the rest of my health care team was concerned when I asked them later, there was no reason for the tests to have been ordered, not that they would have ever said so in writing) or just too darn lazy to check with my primary care physician that such labs had been done within the last year and were unnecessary. (I actually chose to risk my credit rating because I refused to pay the co-pay after notifying my insurance company that the tests should not have been ordered, had nothing to do with my treatment, and that the hospital and physician should be investigated because I was probably not the first person they had used this way–and by the way, I never could get the results of the tests. I was just told “everything was fine.”) Hopefully you would not be the doctor who ignores a DNR order and “saves” the patient who has died on the table (my grandmother) and who didn’t want to live with an amputated leg but had to–and was miserable–for the remaining 5 years of her life, during which she stayed in bed most of the time. And the list continues, but I will end here because this blog is supposed to be about travel. Oh, I have a story about malaria pills that “had to be bought in the US to insure quality,” even though I explained that I had lived in the country I going to visit and had complete faith in the pharmacy at which I would purchase at 10% of the cost here in the US the malaria pills I was going to use. “Thank you for informing me of your thoughts, I know the quality control problems, but did you really need to bring in the medical director because I was unwilling to pay your very inflated price?!”

    There are a lot of great doctors out there and, unfortunately, there are a lot of poor doctors who are protected by good doctors. Working in health care, I have a lot of stories about botched surgeries–one woman had a broken pair of scissors in her body for 7 years because the physician who did her surgery wouldn’t admit that anything might have gone wrong. After regularly visiting doctors in the same medical system, she finally went home to Mexico (and, yes, she was a legal resident of the US!) where they did a “primitive” x-ray and the scissors showed up quite clearly on the film. I actually saw the film, so this is not an urban legend. The hospital provided the surgery to remove the scissors free of charge–how nice!–but for 7 years this poor woman lived in pain and couldn’t pick up her grandchildren or do simple ADLs

    I am sure you are a wonderful doctor, but doctors sometimes think of themselves as gods and this needs to stop. Patients need to become better informed, doctors need to respect patients (who might actually know more about their bodies than the doctors) and EVERYONE should know what costs are being incurred–not so that care can be denied but so that patients can decide if they can afford the care. Alas, in this country, great health care is available to those who can afford it and the rest of us have to accept what is affordable. I think it is simply laziness on the part of physicians not to know the costs of tests and procedures and then expect people to pay thousands of dollars that they don’t have. And, yes, that was not the case for Sue Burgess, but I do understand her distress if she felt that she didn’t need to go to the ER in the first place. As I was not there, I do not know how the paramedics or ER folk behaved, but I have experienced many pushy ER personnel who don’t appear to care about people’s pocket books. Now, if the services were free of charge as part of single-payer system, Ms. Burgess probably wouldn’t have written the letter.

  • Barry Graham

    If she lost consciousness she would not remember. If they had not acted and she had become ill, would she have sued? Probably. I think she should back off, admit she was wrong, apologise for wasting their time in trying to get payment and for being so ungrateful, then she should thank them.

  • hoffnung

    Flt attendant and EMT’s would have high likelihood of being suable if they had not acted in a way to minimize potential for harm. It is absolutely not up to them to decide at the scene that passenger/patient is OK. That is outside their area of (legally constituted) responsibility, because even if the patient is right about ability to continue without assist, she can’t know that and neither could the personnel at scene. Even if there was a lie-down area at airport, that only exacerbates airline liability if passenger is allowed to lie down, and deteriorated. I seriously doubt that a reasonable court would hold airline responsible for passenger’s costs, since airline acted in socially responsible manner. One thing that is odd in passenger’s account is that the hospital would tell her, once she was at their facility and appeared to be not in immediate danger and/or stabilized, that her insurance would not pay if she left AMA. Such a decision is not within the hospital’s competence, though I wouldn’t put it past most insurers to try. (Most health insurers seem never to have heard of a compensable expense when 1st queried.) To bring it up in the circumstances smacks of coercion by the ER, and raises questions about why they would use that line, rather than one based on medical facts, which are in their scope, to try to persuade a patient to stay, or do what appears to be in their own interest.

  • Molly

    For all practical puposes, she should pay the $392. and thank SW crew for calling paramedicis instead of ignoring her. (however they seemed to on the flight by making her get up and throw her barf bags away by herself.

    What bothers me is the inconsistancy of the statement by SW laywers:

    >>>”Southwest Airlines flight attendants state that upon exiting the aircraft you lost consciousness, vomited, seemed lethargic and requested a place to lie down.”<<<<

    How could she be unconscious, yet ask for a place to lie down???? If she were unconscious, she wouldn’t be able to do that, would she? And if she was lethargic, that also proves movement, so again, one can’t be unconscious AND lethargic. It’s one OR the other!
    So although I don’t think SW owes her money, I think their answer stinks of lawyers dancing around and saying anything they think gets them off the hook, allowing no room for logic or making sense.

    Quite frankly, I think the paramedics are at fault by not giving her a choice. And then the hospital is at fault for admitting her against her will.
    Again, for $392. she should pay and shut up. She got medical treatmenr, and who knew if it wasn’t more serious at the time?
    However, if she didn’t have insurance, and got a $9000.00 bill then what would happen?
    As a side note, what would have happened if when she was admitted to the hospital and they asked if she had insurance and she said “no”, would they have then let her go if she chose to?

  • Joe Farrell

    if she left AMA the hospital would not submit her insurance claim? Then they do not want to get paid. I’d love to see them try to collect – we go to court and the following takes place:

    Hospital testifies they accepted, evaluated and admitted her. Then she left AMA. We discover that they were aware she had health insurance. Did they file a claim? No. Why not? Because she left AMA – its hospital policy. So, you [the hospital] were aware that you could get paid but chose not to because you did not like the decision the patient made? Yes, essentially.

    I’d look at the judge at that point and move for dismissal – they caused their own injury because of their own refusal to cooperate. End of case.

  • Cassivella

    @Molly

    Most FAs will tell you that it is not their job to throw away barf bags. If you think hard enough about it, do you really want them handling barf and used-diaper filled bags while they are passing out your pretzels and diet coke? You want them handling used diabetic syringes while they are at it?

    With the exception of healthcare providers, I don’t expect anyone else to deal with any of my bodily fluids – especially when I am sick.

    The woman should have never been on that plane to begin with. If we want to fault Southwest for anything, it would be for allowing her to board and put all the rest of the passengers in danger.

    @Joe and others

    I am sure the hospital would have submitted a claim. And I am sure that many insurance companies would deny the claim. I know my private insurance has a clause that states they will not pay if I leave against medical advice. I also know that the state-funded insurance programs here in Ohio also will not pay AMAs (I used to work in a hospital).

    The reason for this is that a patient leaving a hospital AMA has a much greater chance of returning to an acute care center in the next few days. And the medical expenses of someone who, say, ignored medical advice to get an angiogram to see if there is a clogged artery and who is returned to the hospital with a major heart attack, loss of oxygen to the brain, and by-pass surgery is exponentially more than if the patient had stayed and simply had a balloon done.

    The hospital does have reason to advise patients against leaving AMA. The hospital is more likely to get paid if the insurance covers the bill than if the patient leaves and is stuck with $8,000 that they refuse to pay on principle. So, the hospital representative may have erred in saying the claim wouldn’t be submitted, but the end result was the same – the claim wouldn’t be paid.

    @Chris

    Last time I flew Southwest, the guy next to me got two bags of peanuts, and I only got one. Customer service has ignored my request for an additional bag to be mailed to me. Do you think you could find time to contact them?

  • Cassivella

    LOL – the comments section here filters out any tags, so my above comment is missing my sarcasm tags LOL

    I’ll let you figure out which part was a joke…

  • Christopher Elliott

    @Cassivella, I’m right on it. Justice will be done!

  • http://www.roamingtales.com Caitlin @ Roaming Tales

    Southwest may or may not have looked after her during the flight but they absolutely did the right thing, both morally and legally, in calling the paramedics when she got off the plane. There was no other course of action available to them, given Burgess’ own account.

    There is no charge if paramedics come to check you out but you don’t go to hospital. If Burgess didn’t want to go to hospital, she should have told the paramedics firmly that no, unless this was life-threatening, she would phone a friend instead. If she was incapable of doing this at the time, well then the paramedics clearly made the right decision to take her to hospital.

    Sometimes in life you can be unlucky – I’m referring to Burgess getting sick, not the excellent treatment she received from Southwest and the paramedics.

  • ValB

    Southwest is absolutely right… she should not have been flying sick anyway… regardless, they did the right thing in trying to take care of the passenger. if medically trained people determined that she needed to be in the hospital, SW is not responsible… it’s only $392 and if it had been me, i would have been thanking Southwest, not trying to get them to pay for my healthcare!

  • Steve Yanowsky

    I suffered from hallucinations andsaw my therapist the next day. Later in the day I was advised by an urgent care unit to go to the emergency room. I reall did not wish to go to the hospital. When I declined, my therapist called 911 and sent an ambulance to my house to take me to the hospital. This made no sense./ I can walk to the hospital if I planned to go. I cant be forced to go. it wasnt an emergency. Now Im going to be stuck with an ambulance bill which I think my therapist should be responsible for or at least pay a portion of it. I go to therapy to get help not to make matters worse and it doesnt help to get another bill when im practically bankrupt right now. The law must be changed.

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