Freedom trail, check; Faneuil Hall, check; Boston Harbor, check; Massachusetts General Hospital?

December 17, 2010
Arun Krishnaraj, MD, MPH

Laura and her husband Paul landed in Boston to begin a whirlwind tour of several major East Coast cities in celebration of their second wedding anniversary. As a Brit, Laura most looked forward to touring the sites of the city that helped ignite the American Revolution. Following a bowl of “chowda” and a few pictures along the Charles River, they would bid farewell to Beantown and headed toward the bright lights of the Big Apple.

Laura and her husband Paul landed in Boston to begin a whirlwind tour of several major East Coast cities in celebration of their second wedding anniversary. As a Brit, Laura most looked forward to touring the sites of the city that helped ignite the American Revolution. Following a bowl of “chowda” and a few pictures along the Charles River, they would bid farewell to Beantown and headed toward the bright lights of the Big Apple.

Massachusetts General Hospital, though a historic hospital, was not included in their itinerary but became a last minute addition when Laura began to suffer abdominal pain. She hoped to be able to attribute the pain to the chowder she’d eaten a few hours prior but knew her condition was more serious when she noticed the bleeding. While this would raise concerns for most women, Laura suspected she might be pregnant, further complicating the matter. Laura and Paul had discussed starting a family in the coming months and the excitement of telling Paul she was pregnant with their first child had been welling inside her as she contemplated the perfect time and place in which spring the news. But this was not it. Not now. Not this way. Was it over before it had begun?

Laura entered the MGH emergency department at approximately 2 p.m. She was registered and evaluated by the ED staff. Blood chemistries, a complete blood count, IV fluids, and Tylenol were ordered. Confirming Laura’s suspicions, the pregnancy test returned positive. The screening blood tests detected no other abnormalities. The ED physician then ordered a pelvic ultrasound to evaluate for the presence of a viable pregnancy.

Shortly after Laura arrived in the department of radiology, I performed an ultrasound and discovered a twin pregnancy. Laura and Paul’s excitement was short-lived as their thoughts immediately turned to the health of the pregnancies. I detected a consistent heartbeat in one pregnancy but could capture heart tones only transiently in the second fetus. I explained to Laura and Paul that the pregnancies dated approximately five weeks by size. At this early stage, detecting a steady heartbeat can be difficult. I attempted to allay their fears by listing the most common benign causes of Laura’s bleeding and recommended she receive a repeat ultrasound before returning to England as a precaution. By 7 p.m. her bleeding had subsided and she was discharged from the ED.

Laura and her husband did not purchase travel insurance before visiting the U.S. I assume they, like most travelers, deemed it an unnecessary expense for a short, two-week trip given their young age and relative good health. Following her visit I was interested in learning how much Laura’s five-hour visit to the ED would cost, since technically she was “uninsured.” After phoning the MGH billing department I was surprised to learn that Laura’s encounter will cost her $4398. As a radiologist I took specific interest in the costs surrounding the ultrasound, approximately $877. Further discussions with the billing representative revealed that Laura would not be afforded any discounts as an uninsured patient or foreign visitor. She would be granted a 25% discount if she paid in full within 30 days, but this would still leave her with the not-so-tiny sum of $3300. If the positions were reversed and my wife and I were in need of emergent care in a London hospital, our cost of care would be $0.

Laura did not return to MGH during her remaining time in Boston. I hope she received a follow-up ultrasound in New York and heard two strong heartbeats. I am sure Laura and Paul were anxious to return home and greet their family and friends with the good news of their pregnancy and classic American souvenirs like a Boston Red Sox hat. Unfortunately, I fear Laura and Paul will be greeted by a hefty medical bill.


Dr. Krishnaraj is a clinical fellow in the abdominal imaging and intervention division, department of imaging, at Massachusetts General Hospital/Harvard Medical School. He can be reached at akrishnaraj@partners.org.

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