It’s a gruesome calculus that far too many people are forced to make in the heat of some of the worst moments of their lives

I guess they thought I was going to kill myself. I was sitting in my doctor’s office complaining about abdominal pain, and the conversation drifted to how I’d been feeling emotionally. “Did I ever have thoughts about suicide?” the doctor asked.

“Who doesn’t, am I right? Haha,” I replied.

The doctor said she’d be right back, and it dawned on me a second later what was about to happen.

Ah. Shit.

The next thing I knew an ambulance and the police were there — very good response time! But come on, I explained. There was no way I was getting in that ambulance. I really cannot afford it. And besides, if I was genuinely suicidal, would I really be worried about paying a bill?

The real joke, I’m only just now realizing a few years later, is that the ride would’ve been covered by my insurance — I think. There are so many factors that go into figuring out the cost of health-care concerns, and emergency transportation services in particular, including whether or not the EMTs, and separately, the hospital in question, are in your insurance network; how long the trip will be; the level of skill of the professionals on hand; and the types of services provided — oxygen, medications, CPR etc. — that even looking at the language in my insurance now, I still can’t be certain.

Clearly it’s not in our best interest to have paramedics running a credit check on the scene in an emergency before saving our lives, but that’s exactly what many of us end up doing on our own behalf. It’s a gruesome sort of calculus — exactly how much blood am I losing here? — that far too many people are forced to make in the heat of some of the worst moments of their lives.

Last week, though, Uber announced a new offering called Uber Health, a service that would allow medical staff or doctors to arrange for rides for patients. Oh, wow, the tech industry invented ambulances, was one exceptionally common retort on social media. Uber is bad for all manner of reasons but it’s clear this isn’t meant as a substitute for ambulances, but rather, as a means for getting patients a reliable ride to appointments they might not otherwise get to. That said, the discussion was a reminder that there already is an Uber for Ambulances: It’s called regular Uber.

Often, for a story like this, a writer might put out a call on social media asking for people to talk about a particular subject, as I did here about men injuring themselves or here on mansplaining. A lot of times, depending on how specific the request is, it can be difficult to find enough voices. When it comes to the topic of avoiding an ambulance because of concerns about how much it would cost, on the other hand, the response I got was overwhelming, with dozens of people eager to vent.

In the past couple days I’ve heard stories about people who had their credit permanently destroyed after a handful of ambulance rides being transferred between hospitals, not fully aware of what was happening, and not really in a position to object. People spoke of walking to the hospital and almost passing out along the way with severe burns or lacerations. More than a few told me about having to get into arguments with the EMTs, telling them in no uncertain terms that, no, they did not have to go with them. Others weren’t so adamant and regretted taking the ride when police or emergency personnel were more insistent.

“I wouldn’t take an ambulance now unless it was life-threatening,” Mike Taggart tells me. A couple of years ago, he was walking through a mall in Cambridge, Massachusetts, when suddenly his head started ringing. Someone had thrown something off the balcony above and hit him in the head, which promptly started bleeding. “Someone called 911, and when they came, they were like, ‘You need to go to the hospital, and we have an ambulance,’” he says. “In my ignorance, I was like, ‘Okay.’”

The hospital they took him to was less than a mile away, but when the bill showed up, it was almost $2,000, he says. “I wasn’t thinking straight at the time. I had insurance, but the deductible was huge.”

“I always joke to my friends that if they find me dying, and they call me an ambulance, I’ll come back from the dead to fight them because it’s so expensive,” says Adam Lundgren. “But that joke comes from a real place of fear of being stuck with a bill I can’t pay.”

He’d heard enough horror stories from friends about the costs of an ambulance over the years that when he fell down some stairs and broke his arm, he said screw it, and drove himself to the hospital in pain. “I’d absolutely do it again, too,” he vows. “It sucks, but I feel like it’s necessary.”

The list goes on and on.

One friend, who actually works in a hospital on the administrative side, had a sudden stomach flu and asked for an ambulance. It arrived and took him a few doors down to the emergency room — for a cool grand. Another, a nurse, was billed $3,300 for a few miles ride and paid $1,000 out of pocket. Yet a third says, “I drove myself to the emergency room hemorrhaging from a surgical complication because I knew the ambulance ride wasn’t covered by my insurance.” And a fourth: “Last year I was unconsciously put into one so I never paid the bill. The way I see it, I was kidnapped.”

Nick Johnson was on the train in Boston when it got into a crash six years ago. He hit his head on the ground, and the first responders instructed him to go to the hospital, so he did, along with five other people. “Five months later, I got a $900 bill that my insurance wouldn’t cover and that decimated my savings,” he says. “This for an accident that happened on public transportation and [an ambulance] that was shared with others. I’ve maintained a healthy fear of ambulances ever since. I had a really bad illness last year that caused me to be briefly hospitalized. My folks told me to call 911, but scared of the cost, I walked the 5 to 10 minutes to the hospital.”

Jon Payne blacked out after over-exerting himself at the gym a couple of years ago. An employee found him sprawled flat on his back in the bathroom. “He gave me a bottle of water and told me an ambulance was on the way. I immediately thought about the cost,” he says. He has insurance, but it’s subject to a high deductible. “I was like, ‘Yeah, no, fuck that. I’m fine.’ I got my bearings back a few minutes later, and I left right at the same moment the ambulance was pulling up and the guys were getting the stretcher out. I walked right passed them like a slick bank robber.”

Imagine that? Slinking away from the people sent to help you.

Paul Adler developed epilepsy at age 26. His first seizure, years back, happened while he was at work in New York, and his boss called an ambulance while he was out of it. The bill for the ride was around $1,200, he remembers. Thankfully, he had insurance at the time, but since then, when he hasn’t, or has taken on new jobs and been in between insurance, he makes a point to ask his co-workers not to call him an ambulance in the event something happens. “I’ve requested that they wait until I regain consciousness and cognizance so I could get myself to a hospital [in an Uber or taxi] instead of shelling out another $1,200 for a ride,” he explains.

Please, everyone, do not help me.

It reminds me of the shitty old Reagan joke about the scariest words you can ever hear, except in this case it’s, “We’re the government, and we’re here to save your life.”

One complicating factor here, however, is that the people who come to help you aren’t always the government. In every city and state throughout the country, you’ll find a wide variety of services — from taxpayer-funded fire departments with EMS personnel to hospital-based services to private companies to, often, in larger cities, a combination of all three and more. And when it comes time to pay the bill, as in all of the confounding, complicated corners of our byzantine health-care system, the buck often gets passed around. Knowing that some high-end insurance companies will pay the full rate, while others will not, or that the people being helped might not be able to afford any of it, many emergency responders will charge as much as possible, hoping the ones who pay full freight subsidize the rest of us.

Our municipalities know all of this, too. In fact, getting people to take fewer ambulances is something that cities around the country, like Washington D.C., have been attempting to facilitate. In others, like Phoenix, medical taxi vouchers are offered as a means to dissuade people who might otherwise have to rely on ambulances for non-emergency medical transportation. The reasons why are pretty obvious: One, it frees up limited resources for more serious emergencies — a good thing! Two, it’s an acknowledgement that people are increasingly unable to pay for ambulance bills that can range anywhere from a few hundred dollars to multiple thousands of dollars, something most of us don’t find out until after we’ve already agreed to the ride.

Much of the cost has to do with the fact that ambulance companies and insurers often can’t agree on what a fair price should be, and therefore, ambulance companies may not contract with insurance companies so they can charge more as out-of-network providers. Complicating things further is that the mercurial nature of this billing can open the door for fraud and abuse. Case in point: Last year, Medstar Ambulance, Inc. in Massachusetts was ordered by the U.S. Attorney’s Office to pay $12.7 million in fines for inflating Medicare claims for ambulance transports.

Of course, the federal government has a lot more resources to invest into making sure they’re not being erroneously billed. Most of us don’t have the wherewithal to protect ourselves after the fact, which is why the difficult choice has to be made on the fly. But perhaps that’s an idea — providing the government with sufficient funds through taxes that are then used to administer necessary services for its citizens.

That’s just crazy enough to work, right?

In the U.K., to give one example, emergency services, and almost all other health-care concerns, are provided free at the point-of-service. It’s not a perfect system, as it can lead to abuse, but it’s far better than the nightmare life-or-death game show we have here. Truly the American spirit of self reliance at work: Pull yourself up by the gurney straps.

In the meantime, as ever in our hopelessly broken system of health care, that may be our best hope when it comes to emergencies. Look out for yourself, because no one else is going to.

Even the people there to save the day.

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This essay also appears in Luke O’Neil’s book Welcome to Hell World: Dispatches From the American Dystopia.