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Shaunti Meyer, medical director at the STRIDE Community Health Center in Aurora, Colo., says she discloses her sexual orientation to patients when it feels appropriate. Rachel Woolf/Rachel Woolf for KHN hide caption toggle caption Rachel Woolf/Rachel Woolf for KHN Shaunti Meyer, medical director at the …
Thousands and thousands of Us residents have irritable bowel syndrome and the anxiety of the previous two yrs may perhaps have exacerbated tummy difficulties. There are ways to aid, like meditation and practicing mindfulness. Alvaro Tejero/EyeEm/Getty Images hide caption toggle caption Alvaro Tejero/EyeEm/Getty Pictures Thousands …
Suzanne and Jim Rybak, inside the craft room where their son, Jameson, would encourage Suzanne to make colorful beach bags, received a $4,928 medical bill months after it was supposedly resolved.
By Gavin McIntyre/Kaiser Health News
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By Gavin McIntyre/Kaiser Health News
Suzanne and Jim Rybak, inside the craft room where their son, Jameson, would encourage Suzanne to make colorful beach bags, received a $4,928 medical bill months after it was supposedly resolved.
By Gavin McIntyre/Kaiser Health News
Every now and then, Suzanne Rybak and her husband, Jim, receive pieces of mail addressed to their deceased son, Jameson. Typically, it’s junk mail that requires little thought, Suzanne said.
But on March 5, an envelope for Jameson came from McLeod Health.
Jim saw it first. He turned to his wife and asked, “Have you taken your blood pressure medication today?”
He knew showing her the envelope would resurface the pain and anger their family had experienced since taking Jameson to McLeod Regional Medical Center in Florence, S.C., two years ago.
As KHN previously reported, Jameson was experiencing withdrawal symptoms from quitting opioids. Suzanne feared for her son’s life and took him to McLeod’s emergency room on March 11, 2020.
There, they encountered a paucity of addiction treatment and the potential for high medical costs — two problems that plague many families affected by the opioid crisis and often lead to missed opportunities to save lives.
Jameson was not offered medications to treat opioid use disorder in the ER, nor was he given referrals to other treatment facilities, Suzanne said. The hospital wanted to admit him, but, being uninsured, Jameson feared a high bill. The hospital didn’t inform him of its financial assistance policy, Suzanne said. And he decided to leave.
Three months later, Jameson, 30, died of an overdose in his childhood bedroom.
In the following months, the Rybaks received bills from McLeod Health addressed to Jameson. He owed $4,928, the bills said. Suzanne called and wrote to hospital administrators until September 2020, when the bill was resolved under the health system’s financial assistance program.
That was the last they had heard from McLeod Health until the new envelope arrived March 5 — one week before the two-year anniversary of Jameson’s ER visit. That visit was what Suzanne calls “the beginning of the end for my son.”
When the Rybaks opened the envelope, they found a strikingly familiar bill for $4,928.
“I can’t even describe my anger and sadness,” Suzanne said. “It’s always present, but when we received that statement, we were just stunned.”
There’s no national data to indicate how often patients or their families receive medical bills that were previously paid or forgiven, but hospital billing experts say they frequently see it happen. Patients might receive bills for claims their insurers already paid. A reminder statement may arrive even after a patient has submitted payment.
Unlike “surprise bills,” which often result from policy gaps when a provider is out of network, these are bills that were resolved but continue to pop up anyway. They can carry financial consequences — patients wind up paying for something they don’t truly owe, or bills get passed on to debt collection agencies, triggering more phones calls and red tape. But often it’s the emotional toll that wears on patients most, spending hours on the phone with customer service each time the bill resurfaces or reliving the situations that led to the bill in the first place.
For families like the Rybaks, the cost can feel never-ending. Suzanne Rybak refused to engage with McLeod Health again but told KHN about the new bill. In response to questions from KHN, McLeod Health determined the bill that the Rybaks received was a mistake.
“Unfortunately our software system regenerated this statement due to a technical issue,” wrote spokesperson Jumana Swindler. “We are checking to ensure that it has not happened to any other patients and we are sorry this family was impacted by the error.”
A week after KHN’s inquiry, the Rybaks received a letter from the hospital explaining and apologizing for the mistake.
Many medical billing cases like this “boil down to human error,” said Michael Corbett, director of health care consulting for LBMC, a Tennessee-based firm that consults with health systems nationally on issues like billing and revenue. “Facilities don’t have a lack of tools [to avoid this.] It’s a breakdown in their processes.”
A billing agent may forget to mark the account as paid, he said. Or the hospital might contract its billing to an outside company and fail to inform them that the bill was covered under the hospital’s financial assistance program.
As hospitals and medical practices increasingly consolidate under large health systems, the chances for errors increase. Even hospitals and clinics within the same system may have different backend software, and within each hospital there can be separate programs for billing and electronic health records, Corbett explained.
Larger health systems may also have more people processing any given bill. If responsibilities are not clearly defined, multiple employees could unknowingly act on the same patient account.
The COVID-19 pandemic has exacerbated potential errors, Corbett said. New medical billing employees may have received quick, virtual training and are working remotely with little interaction with team members or oversight. Some billing departments are understaffed, leading to delays in patients receiving bills or follow-up notices, he added.
To curb mistakes, Corbett said, hospitals need to invest in more comprehensive training and supervision for billing employees; enact consistent processes for everything from how patients’ financial information is collected at registration to when they’re sent bills; and, perhaps most important, track whether those processes are being followed.
For patients who find themselves in a situation like the Rybak’s, Corbett advises calling the hospital billing department and asking to speak with a senior leader in its revenue cycle division. Unlike an account representative, this person could make decisions, Corbett said.
At the end of the conversation, ask to get the explanation in writing, he added.
“You’d anticipate and hope those notes are being recorded,” Corbett said, but that may not be the case. Or notes might get recorded in a section of hospital files that are excluded from a patient’s legal medical record, making it difficult for patients to access later.
For Suzanne Rybak, the idea of calling McLeod Health to straighten out yet another bill was too much. Instead, she added the statement to a binder of paperwork, in which she’s documented all her billing struggles with McLeod Health over the past two years.
Still, out of sight hardly means out of mind. The binder sits in her craft room, where she remembers Jameson encouraging her as she made beach bags and other items. He’d say to use “fruity colors,” Suzanne recalled — his way of describing tropical colors. Now she makes candles in that room, focusing on tropical fragrances she knows Jameson would have loved.
“I want hospitals to realize that you’re not just sending this bill to an address,” Suzanne said. “There are people who live in that house, who are going to open that mail and have feelings. … It’s a disaster to bring all that up again.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. It is an editorially independent operating program of KFF (Kaiser Family Foundation).
Stacey Whitford applied for Medicaid for herself and her son in December. He needed the coverage for hearing aids, and they waited for months as Missouri officials processed thousands of applications. Christopher Smith/KHN hide caption toggle caption Christopher Smith/KHN Stacey Whitford applied for Medicaid for …
Klaus Vedfelt/Getty Illustrations or photos Klaus Vedfelt/Getty Photographs Turning off the lights and closing the curtains is just not just a catchy, new sleep cleanliness hack, but this frequent perception advice is getting even extra scientific trustworthiness. Lots of Americans rest in a place that’s …
Close friends Joshua Paredes, Michael Walujo and John LeBlanc are working together to set up a crisis help line for nurses following the suicide of their friend Michael Odell in January.
Rachel Bujalski for NPR
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Close friends Joshua Paredes, Michael Walujo and John LeBlanc are working together to set up a crisis help line for nurses following the suicide of their friend Michael Odell in January.
Rachel Bujalski for NPR
On the morning of January 18, Joshua Paredes came home to an empty apartment. His roommate and good friend Michael Odell wasn’t there, but there was a giant bag of Skittles, Odell’s favorite snack, on the dog bed.
Paredes, who has two dogs, texted his friend. “I was like, ‘Oh my gosh, how many Skittles were in here? Just so I know what’s going on with the dogs.'”
They were both working as nurses – Paredes at the University of California, San Francisco hospital and Odell at Stanford Health Care – and initially, Paredes didn’t think much of his friend’s absence, since he typically came home a little later.
When he didn’t hear back, and Odell didn’t answer his call either, Paredes looked for his friend’s location on his phone – they shared locations with each other. It showed him on a highway that he never took to come home.
“So I kind of realized something was weird,” says Paredes.
He then called his friend’s workplace and learned that Odell had left work around 4:30 a.m. to get something from his car. But he never came back.
Paredes started calling Odell’s other friends to raise the alert.
“When I found out that he left mid-shift, my first thought was he’s in crisis,” says John LeBlanc, a nurse at UCSF, and a good friend of Paredes and Odell. “Because it’s totally, completely out of character for him.”
Two days later, after a search by friends, volunteers and the police, the authorities found Odell’s body. While the investigation into his death is still ongoing, the evidence points to suicide. He was 27 years old.
Michael Odell, a critical care nurse, had spent the past two years traveling between assignments in California and Minnesota. In December, he started a stint with Stanford in the midst of the Omicron surge.
Joshua Paredes
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Joshua Paredes
Michael Odell, a critical care nurse, had spent the past two years traveling between assignments in California and Minnesota. In December, he started a stint with Stanford in the midst of the Omicron surge.
Joshua Paredes
If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.
For Odell’s group of close friends, his death was crushing.
“It’s been hard,” says Michael Walujo, a critical care nurse at Stanford, and a close friend who traveled with Odell for several years as a travel nurse before the pandemic hit.
As the reality of his friend’s death has sunk in, Walujo says, he has felt sad, then angry at his friend, then angry at himself for not being able to help more.
“It’s just been a roller coaster of emotions, honestly,” he says.
Odell’s death was also a wake-up call for the many health care workers who heard about it.
The day that he disappeared, Paredes created a Facebook page called “Find Michael Odell” to ask volunteers to help. He also requested help on the Stanford nurses’ union Facebook page. He was surprised to see an outpouring of support and stories of personal struggles from fellow nurses.
“There’ve been people that reached out to me, they didn’t even know Michael,” says Paredes. “They just wanted me to know like, ‘I worked on this unit. I experienced this.’ I got one person telling me that his co-workers had to wheel him to the emergency room from the ICU at that hospital because he was having a breakdown.”
Now Odell’s friends and other nurses are calling for change in their industry. They want to see more support for their colleagues dealing with the emotional fallout from the pandemic – people who for two years have put in grueling hours together fighting a brutal virus.
They want to employers to create a less stressful, more supportive work environment with better access to mental health care, and a culture where it’s ok to ask for help.
But they’re worried that change won’t come fast enough. So they’re taking things into their own hands by being more open about their own mental health, and creating a way for nurses in crisis to get support from their peers.
Doctors and nurses there’s a feeling that the ones who heal others, not the ones who need to ask for help, says Paredes.
“We have a lot of shame involved in it,” he says. “I think that stigma will be the last to die with health care professionals, to be honest with you, because we just don’t talk about it.”
But his friend’s disappearance and death seems to have broken a wall of silence around the topic. “If we don’t talk about it, it’s not going to get better,” says Paredes.
Most nurses and other frontline health workers worked relentlessly over the past two years, surge after surge, through countless deaths and severe staffing shortages. And now, a majority are struggling with psychiatric symptoms, research finds. Mental health care providers worry that they will soon see a wave of associated problems, like substance abuse and suicide risk.
“I do think it’s going to be a problem long term,” says psychologist Barbara Rothbaum at the department of psychiatry at Emory School of Medicine. “I think the trajectory of their careers, of their lives are not going to be the same because of these experiences.”
A recent study showed that more than 70{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} of health care workers in the country have symptoms of anxiety and depression, 38{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} have symptoms of post traumatic stress disorder, and 15{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} have had recent thoughts of suicide or self-harm.
“I think there’s definitely more PTSD, and over time we’ll see more and more of it when people settle and realize what this experience has been like for them,” says psychiatrist Jessica Gold, at Washington University in St Louis, who specializes in burnout among health care workers.
“You hear it in people describing how in their dreams they see [things] like body bags,” she says. “Or, a lot of these anxiety dreams where they’re not in control. Like a building’s on fire and they can’t get there.”
“When you’re doing shift after shift and you’re just exhausted, you don’t have time to emotionally process it,” says Rothbaum, and that increases risk of PTSD. “It’s similar to when people are in a combat zone. But at some point you do need to respond as a human and put it back together.”
Paredes, who is also a nurse, says his friend’s death struck a nerve. “I think mental health is something nobody likes to talk about because it’s uncomfortable. But when something like this happens, it becomes very real.”
Rachel Bujalski for NPR
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Rachel Bujalski for NPR
Paredes, who is also a nurse, says his friend’s death struck a nerve. “I think mental health is something nobody likes to talk about because it’s uncomfortable. But when something like this happens, it becomes very real.”
Rachel Bujalski for NPR
Michael Odell didn’t have a chance to do that, especially in the early days of the pandemic.
He had his first emotional crisis in the spring of 2020, after several weeks of working with COVID-19 patients. He was a travel nurse in the San Francisco Bay area at the time and attempted suicide.
He took some time off, but then moved to Minneapolis for another travel nursing gig, as COVID spread around the country.
His nurse friends in California started “Wellness Wednesdays,” to check in with him and each other regularly and provide emotional support, Walujo says. A lot of what they talked about was witnessing death every day, which wasn’t the norm before the pandemic.
“Like every other hour, you get a new patient and then they also die. And you really don’t realize how traumatic it is until you’re having a moment when you clock off, and think about [what happened in] the last 12 hours,” Walujo says.
Odell used to talk about how hard it was to watch so many patients die alone, says Paredes.
“He was these patients’ everything,” he says. “He was there when they were dying.”
The heaviness of work during the pandemic hit Odell particularly hard. He was the kind of person who “cared deeply about everybody he met,” says Paredes. “He took time to get to know people and get to know their stories.”
And his patients loved the attention and care he gave them. Many “would just brag about how good of a nurse he is, what exceptional care he’s given them,” says Walujo, who often worked in the same hospital as his friend when they used to travel together.
After his first suicide attempt, Odell sought treatment. He started seeing a therapist regularly and got on medication. But last year, he went through a break up and lost his mother to dementia.
Paredes, who didn’t want his friend to be alone at such a vulnerable time, suggested he move back to San Francisco. Odell moved into Paredes’ spare bedroom in late 2021 and started a new assignment at Stanford. He had three months’ refill for his depression medication, but was waiting for insurance to kick in to continue treatment.
But there were no obvious signs that he was still struggling, says Walujo, who saw him almost every day. “So this all just came out of nowhere.”
When Sarah Warren, a nurse in Florida, read about Odell’s death, she says, the loss felt personal to her.
“It’s only a matter of time before this happens to another nurse,” says Warren, who has had her own mental health struggles after working with COVID-19 patients since the early days of the pandemic.
Nurse Sarah Warren, in Fort Myers, Fl., read about Odell’s death on Twitter. She connected with Paredes and together with Walujo and LeBlanc, they began talking about solutions.
Tristan Wheelock for NPR
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Tristan Wheelock for NPR
Nurse Sarah Warren, in Fort Myers, Fl., read about Odell’s death on Twitter. She connected with Paredes and together with Walujo and LeBlanc, they began talking about solutions.
Tristan Wheelock for NPR
“Going into 2021, I realized I’d actually forgotten large pieces of 2020,” she says. “I had to speak to a therapist about this, and they told me that I most likely was suffering from symptoms of PTSD.”
Warren and Paredes connected on Twitter and they began to talk about potential solutions, along with Odell’s other friends, Walujo and LeBlanc. They wanted to take their grief and turn it into action.
“We’re in the process of hopefully creating a mental health movement dedicated to his memory, but also to those nurses that we’ve lost not only in the last two years but in the last few decades,” she says.”Sadly, our hospital systems aren’t being held accountable and they aren’t providing us with the support we need.
Physicians already have a dedicated crisis line they can call. So, Warren and Odell’s close friends decided to create a peer support crisis line “where nurses and CNAs [certified nursing assistants] would be able to call a phone number and receive a listening ear, and it’s someone who knows what they’re going through,” says Warren.
It’s “almost like we’re saving ourselves,” she adds.
The new project, which they’re calling Don’t Clock Out, will focus on suicide prevention.
“The idea behind it is ‘Don’t clock out of life,’ you know?” says LeBlanc. “It came from the fact that Michael Odell left before the end of his shift.”
About 250 healthcare workers have signed up to provide support to their colleagues. And a law firm is providing pro-bono support to help get their group chartered. They hope to launch in the next couple of months.
“We want nurses to realize that you’re not alone,” says LeBlanc. “You don’t have to check out early. You know, we’re here to talk to you before you take those last drastic steps.”
They’re also getting help from a non-profit that helps military veterans cope with their mental health struggles.
“Veterans are in a unique position to be able to provide some insight and also help our brothers and sisters that are in the nursing field and frontline health care workers,” says Sean Dalgarn, executive director of Growing Veterans, which trains vets to provide emotional and informational help to their peers.
There’s significant overlap between what soldiers experience at war and what health care workers have been through the past year, he says, that put them at a higher risk of PTSD and suicide.
And peer support has helped many veterans, says Dalgarn. Studies have found widespread benefits — from improvements in symptoms of depression and PTSD to making people more likely to engage in their own care. In fact, it’s been so useful that the Department of Veterans Affairs has incorporated peer support specialists into its primary care clinics.
“If you’re able to access people in an early stage of whatever they’re experiencing, then that’s a crucial catch,” says Darlgarn. “You have to [get it] before it becomes something that can unfortunately lead to suicide.”
Odell’s friends hope their efforts will make it easier for their colleagues to reach out for help.
“My goal is first and foremost to raise awareness and provide some advocacy for health care workers,” says Paredes, “For not only people who are in crisis, but anybody who needs some support. Call before the crisis. Call whenever you’re starting to feel a little bit stressed.”
Peer support can be crucial, but many doctors and nurses think that the healthcare industry should do more to help their profession deal with the fallout of the pandemic.
Odell’s death was a stark reminder about the problems in the system, says Kathy Stomberg, vice president of the Committee For Recognition of Nursing Achievement (CRONA), the labor union representing nurses at Stanford and Lucile Packard Children’s hospitals.
“I think for many people it was kind of an ‘aha’ moment,” she says. “He had to have been suffering a lot to get to the point where not only wanting to take his own life, but reaching the point where he abandoned his job in the middle of a shift. That has to have been some really significant anguish.”
Her union has been negotiating for a contract that would lessen the burden on nurses and improve access to mental health care. They’ve asked for a special bank of funds to allow nurses to spend up to $2,000 a year on mental health, to cover out-of-pocket expenses which can deter people from seeking care. They also want improvements to the Employee Assistance Program that would cut the weeks-long wait times for appointments.
But so far, most proposals have been rejected, says Stormberg, including one to have more paid time off. “The explanations the hospital gave was ‘that will make nurses less available to us.'”
The union’s proposal also includes measures to address the long-standing staffing shortages that reached crisis levels during the pandemic and significantly worsened burnout and mental health among those on the frontlines, she adds. But “the hospitals have not wanted to acknowledge how short-staffed we are. They don’t want to acknowledge that relying on travel nurses and staff nurses working overtime shifts isn’t sustainable. People are worn out.”
In an email, Stanford Health Care spokesperson Julie Greicius told NPR that “we are committed to working with the union to reach mutually acceptable agreements our nurses can be proud of and support.”
Paredes, who once worked at Stanford, isn’t convinced the hospital is doing enough to help nurses and other frontline providers struggling with stress and psychiatric symptoms.
“It’s a long-term problem now,” he says, and one that cannot be solved without serious investments and efforts by hospitals and the health care industry.
“They need to do more to protect us,” he adds. “They have a moral obligation to protect us.”
