Sunday, March 28, 2010

The "Not A Bill" Bill

We got a "This is not a bill" bill from the hospital stay a few weeks ago.

To recap, a few weeks ago, Tristan had a tactile hallucination at school that ants were crawling all over him and he promptly stripped his clothing off in the classroom. Thankfully, he was in his special education classes at the time and there were only four children there at the time (and I'm inclined to think they might be used to unusual behavior.)

His psychiatrist urged us to take him to the ER, which we did. The ER persuaded us to allow him to be admitted. We had already been discussing having Tristan admitted for 7 days to introduce depakote quickly in a safe setting, so we agreed. Unfortunately, his doctor was called away on emergency leave to the mainland the same day Tristan was admitted, so we were at the mercy of the doctors at the hospital.

Tristan's birthday was the following week and we promised him he would not be in the hospital for his birthday. And why should he be; he wasn't unsafe.

We admitted him with the understanding that he was there simply to begin the depakote. We expressed that to the admitting nurse, his social worker (at the hospital,) and the attending doctor. They initially agreed, but the doctor decided he didn't want to do it that way.

Dr. B wanted to take him off all his medications and start fresh. We did that last year when Tristan was hospitalized for four months while I argued with doctors.

At that unit, they took him off his mood stabilizers and put him on Concerta. Their theory was that Tristan was "merely" ADHD and the Concerta would control his symptoms. They kept insisting that "bipolar diagnosis in children is very controversial and we don't like to put that name on it." My thinking was, if it fits, why wouldn't you put that name on it? When the Concerta didn't work, they attempted to teach him behavioral management skills. They did this for FOUR months while I kept telling them that it wasn't working. He was having just as many, if not more, violent outbursts. (Let me tell you, hearing your six year old screaming "Mommy!" as the aids dragged him away is heart wrenching.) I finally bullied a resident into giving him a mood stabilizer and within two weeks, he was released and stabilized. It was an "I told you so" moment, but not one that I relished.

So, anyway, I was not about to let Dr. B throw things at the wall and hope they stuck. I knew what our goal and objective was with admitting Tristan this time and wasn't going to deviate at all from that. I argued with Dr. B for two days before having Tristan discharged against doctor's recommendations.

He's had four subsequent hallucination episodes, all including one kind of insect or another. He's insistent that he sees the bugs, which is what scares me.

He was put under the care of a "new" doctor. Dr. M initially diagnosed him as bipolar when he was five and I am glad to be under his care again. Dr. M, to my delight, immediately took Tristan off the Concerta, with no ill effects, and put him on the depakote on an outpatient basis. Dr. M's theory is that the Concerta was causing the hallucinations. Tristan has had one since ceasing the Concerta, so I'm not sure how convinced I am about that, but we can handle the hallucinations at home, since he isn't unsafe.

The "not a bill" bill is scaring me, though. I hope our insurance will cover it, even though we went against doctor's advice. The last facility was about $37,000 a month. If I divide that by thirty days (in a month) we're looking at approximately $2500 for that two day stay, assuming they charge the same rate.

Last time, we also received a bill for the ambulance (they won't allow us to transport Tristan if he's been admitted from the ER.) That bill was $1500! I wish I got paid $1500 to transport a six year old boy twenty minutes down the road. Once I called the EMT company, they resubmitted the bill to our insurance, which covered it, thankfully. He was transported this time by that same company, so I really hope the ambulance is covered, too.

Seriously, it's not bad enough dealing with an illness like this, it's expensive, too!


  1. I can't imagine how heart wrenching it is to have your little one being wheeled away screaming for you, i bawl when i leave my dog for a tooth cleaning at the vets!!! You are one strong lady and you are all in my prayers. On a side note, i once(involuntarily i might add) in college did something that caused hallucinations of bright blue bugs and i occasionally get a little flashback to it, it is creepy becuase i see and feel them and KNOW they are not there..i feel really bad for that little guy...

  2. The only thing that prevented me from walking out of the hospital against medical advice after I was re-admitted following the birth of my son was the fear that my insurance wouldn't pay for my time there if I did. It's taken me a long time to move past the regret that I didn't. That's such a strong thing you did for Tristan, and he's lucky to have parents like you and C.