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Bill Of The Month: Extraction Of Doll Shoes In Girl's Nose Cost $2,659


If you're in the emergency room with your kid, it's scary, and the bill is probably not the first thing on your mind. But a visit to the emergency room can end up getting pretty pricey.

Each month, NPR takes a medical bill to sort through why they can be so confusing and confounding. Today, we look at the case of a pretty big bill for what seems like a pretty simple medical service. It only took a minute or so.

We're joined by Dr. Elisabeth Rosenthal. She's editor-in-chief of our partner Kaiser Health News. Welcome back.

ELISABETH ROSENTHAL: Hi. That's quite a story.

KELLY: Quite a story. So who are we hearing from? What's the story?

ROSENTHAL: Today, we're meeting the Branson family from Las Vegas. They're a young couple with two little girls, Emma and Lucy. And the bill involves a Polly Pocket doll and an emergency room visit.

KELLY: OK. Looking forward to hearing where this one goes. And our guide is going to be reporter Stephanie O'Neill, who visited the Bransons. Let's hear what happened.

STEPHANIE O'NEILL, BYLINE: For the Bransons of Las Vegas, the story of Lucy and the tiny doll shoes is one no one in this family will ever forget. It happened last April. Lucy was just 3 1/2. And on this particular evening, her parents, Katy and Michael, were getting ready for a long-awaited concert. It was to be a special evening, one given to them by Katy's parents.

KATY BRANSON: We had a babysitter coming in, like, less than an hour. We had these tickets. We were really excited. And Lucy comes up the stairs, and I hear (imitating coughing). And I was like, what is going on? And Michael said, why are you coughing?

O'NEILL: But Lucy wouldn't answer them beyond gesturing at her nose, Michael says.

MICHAEL BRANSON: Well, I kind of pulled her back and kind of lifted her head up and put her on our bed. And that's when I could see something up her nose.

O'NEILL: That something was a pair of tiny, pink, plastic doll shoes, one perfectly lodged in each of Lucy's little nostrils. Michael says panic overtook him, while Katy, who was in the midst of readying herself for the date, sprung into full-on mom mode.

K BRANSON: And so I went up with my little tweezers, and I get one little pink shoe out, and I put it on the counter. It's maybe about the size of a Q-tip head.

O'NEILL: Easy peasy, she thought. So she takes a deep breath and reaches into the other nostril. But as Lucy, now 4 years old, explains, it didn't work.

LUCY: The other one was stuck in my nose, and I couldn't - and my mom couldn't get it out.

O'NEILL: Big sister Emma says...

EMMA: And it was hard for her to breathe.

O'NEILL: Emma's 7.

EMMA: It was scary. Lucy, was it scary?

LUCY: Yes.

EMMA: That's what I was thinking.

O'NEILL: Have you ever done anything like that?

EMMA: Never in my life.

O'NEILL: But it is pretty common for kids to stick things up their noses, with some items even requiring surgical extraction. Still, Katy wasn't too worried, even when her tweezers couldn't reach the second shoe.

K BRANSON: I'm thinking, OK, well, I can't get this out. I don't want to hurt her. So I say, OK, Lucy, you need to blow. Like - and then I kind of do the motion of blow. And she goes (imitating inhaling).

O'NEILL: That was a giant sniff.

K BRANSON: And I was like, oh, shoot (laughter).

O'NEILL: After that, Katy knew it was time for the professionals.

K BRANSON: So I said, OK, Michael, you need to go to the urgent care. They should have the tweezers. All we need is - are - is tweezers that are, like, maybe a half an inch or an inch longer than my standard day-to-day tweezers.

O'NEILL: But urgent care didn't have a long enough pair. Next stop, the hospital emergency room. And voila - the ER doc easily plucked the shoe out of little Lucy's nostril.

M BRANSON: And it was probably less than one second - the time they put it up her nose, latched on it, pulled it out. She was out.

O'NEILL: Lucy got a lollipop. Katy and Michael got to the concert. It seemed like their lucky day.

Then they got the bill - almost $2,000 for the ER and almost another grand for the ER doc. And because the Bransons have a high-deductible plan, they're responsible for all of it.

K BRANSON: I thought it was simply an error. I was like, there is no way.

O'NEILL: What's the most you've ever paid for a pair of shoes?

K BRANSON: Oh, my gosh - probably $178. Yeah. They were normally 228, and I had a coupon. I was very proud of it.

O'NEILL: So you've never had a pair of shoes anything close to the cost of these shoes.

K BRANSON: No, I haven't - never had a $3,000 pair of shoes.

O'NEILL: Still, Katy Branson says she remains hopeful that Lucy has learned her lesson.

K BRANSON: But she has said she will never put shoes up her nose again. She's promised.

O'NEILL: And her parents hope that also means she won't be sticking anything else up her nostrils ever again.

For NPR News, I'm Stephanie O'Neill in Las Vegas.

KELLY: Oh, wow. I am in full-on mom myself right there with those poor parents. Elisabeth Rosenthal, you were an ER doc before you moved to Kaiser Health News. Is that right? How common is this - kids in the ER with something they have managed to shove up their nose?

ROSENTHAL: Well, I worked in an adult ER, and grown-ups have mostly learned not to do this kind of thing. But pediatricians say it's very common and very easy to treat if you have long tweezers, which they call forceps - medical lingo. As a kid, I myself put pussy willows in both ears, so I've been there.

KELLY: In your ear. OK. I have been there with - yes - with kids for many things, including things up the nose. But I have never been presented with a $3,000 bill for something that took less than a minute to get out. What's going on here?

ROSENTHAL: What's going on here is that today, everything and anything will be billed and billed a lot. The doctor charged over $900. Katy Branson very smartly negotiated that into half right away. But the hospital charged more than 1,700. And so far, they aren't budging.

KELLY: They aren't. And I'm sure the parents have asked for them to budge. Why aren't they?

ROSENTHAL: Well, their attitude seems to be, an ER visit is an ER visit, and you could've gone to urgent care.

KELLY: They did go to urgent care, though.

ROSENTHAL: Right. And it was a Friday night, and they didn't want to leave Lucy uncomfortable all weekend. And plus, what layperson knows whether or not it's dangerous to leave Polly Pocket shoes up your kid's nose for the weekend.

KELLY: Yeah, you don't want her to keep sniffing in, and they end up in her lungs. And then...

ROSENTHAL: Right. They made a rational decision.

KELLY: So their insurance did not pick up any of this. Explain.

ROSENTHAL: Well, lots of families these days, like the Bransons, opt for a high-deductible plan. That means, in the Bransons' case, they had to spend $6,000 before insurance kicked in. They're pretty savvy. They made a decision that they would set this money aside for, like, a medical crisis. They just never imagined that they'd have to spend this money for a little shoe up the nose.

KELLY: Yeah. And what is the takeaway here? What should they have done differently, particularly - as we said, it's a - it was a Friday night. The pediatrician wasn't there.

ROSENTHAL: Well, a pediatrician might have told them it could safely wait until Monday morning or at least look for other options the next day. So it's important, I think, to have a primary care doctor who can say, beware; there are other options. But they did one really smart thing that others should follow. Instead of getting angry when they saw this bill, they began to push back right away and got a discount from the doctor, at least.

KELLY: A minor point, but I have to ask - whatever happened to the Polly Pocket shoes?

ROSENTHAL: The hot pink ones that caused the trouble disappeared into the playroom vortex. But Lucy and Emma had lots of other Polly Pocket shoes to show us when we visited.

KELLY: (Laughter) It's a danger lurking in every corner.

ROSENTHAL: Yes. Be careful.

KELLY: You can see those pictures, if you dare, at NPR's Shots blog.

Elisabeth Rosenthal, thank you so much for being here today.

ROSENTHAL: Thanks for having me.

(SOUNDBITE OF ISOTOPE 127'S "LA JETEE") Transcript provided by NPR, Copyright NPR.

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