It was supposed to be a fun evening out for Katy and Michael Branson. But their 3-year-old daughter, Lucy, apparently had other ideas.

The couple had tickets for a Saturday night show in April in their hometown of Las Vegas, and had arranged for a sitter to watch their two girls. But as Mom and Dad were getting dressed, Lucy came upstairs to their bedroom coughing and looking rather uncomfortable.

“I think she has something up her nose,” Michael said.

For reasons she couldn’t quite explain, Lucy had shoved a matching pair of pink Polly Pocket doll shoes up her nose — one in each nostril.

Her parents tried to get her to blow her nose to dislodge the plastic footwear, but Lucy could do no better than a few sniffs. Katy found a pair of tweezers and was able to remove one shoe, but the second was too far up Lucy’s tiny nose for them to reach.

Michael took Lucy to a nearby urgent care center, where the doctors had no more luck with the tweezers — called forceps in medical parlance — they had on hand and suggested he take her to the emergency room. At St. Rose Dominican, Siena Campus, in Henderson, a doctor was able to remove the shoe in less than a second, as Michael recalled it, with a longer set of forceps. The doctor typically finds Tic Tac mints up there, he told them. This was his first doll shoe extraction.

“All in all, it was an eventful evening,” Katy said. “My husband makes it back, we go to the show, my daughter’s fine.”

Lucy holds a pair of Polly Pocket doll shoes similar to the ones she stuck up her nose.
HEIDI DE MARCO/KHN
Lucy holds a pair of Polly Pocket doll shoes similar to the ones she stuck up her nose.

The Bransons figured they had weathered another typical night of parenting and didn’t give it much more thought. Then the bill came: $2,658.98, consisting of a $1,732 hospital bill and a $926.98 physician bill.

The Bransons negotiated a reduction of the physician’s bill by half by agreeing to pay within 20 days. But hospital owner Dignity Health declined multiple requests for an interview or to explain how it arrived at the $1,732 total for the ER visit.

“Not every urgent situation is an emergency,” the hospital said in an emailed statement. “It is important for patients to understand the terms of their health insurance before seeking treatment. For example, those with high-deductible plans may want to consider urgent care centers in nonemergency situations.”

The hospital billed the Bransons $1,143 for the emergency room visit and $589 for removing the shoe. The entire $1,732 hospital bill was applied against their deductible.

For public health plans like Medicare or Medicaid, the hospital generally bills an average of $526 for removing a foreign body from the nose and gets an average payment of $101, according to WellRithms, a medical billing review firm.

According to cost reports submitted to Medicare, the hospital’s average cost for the procedure comes to less than $48. That’s less than a quarter of the $222 fee WellRithms recommended and well below the $589 St. Rose charged the Bransons.

The Bransons had options as they chose their employer-sponsored health plan. They picked one with a high deductible of $6,000 per year. So instead of paying $500 more a month in premiums, the family could pocket that difference if they avoided any major health problems.

“I’d rather gamble that I might have to pay it, vs. commit to paying it every month,” Katy said.

The Bransons were ready to cover the full deductible for any emergency that might arise. They just never thought something as simple as extracting a plastic shoe with tweezers would garner such a big bill.

“Kids like to put things in their nose or their ears, for whatever reason,” said Melissa Scholes, an ear, nose and throat specialist with the University of Colorado School of Medicine.

Scholes recently reviewed records from 102 children who came to Children’s Hospital Colorado from 2007 to 2012 with objects stuck in their noses. About a third of those patients were referred to an ear, nose and throat clinic, and about half of those required surgery to remove the object. Doctors were able to remove the object in the emergency room in the remaining two-thirds of cases.

Scholes said pediatricians don’t often have the necessary tools to remove the object. Those can include extra-long tweezers or a catheter with a balloon on the end. The tip of the catheter is snaked past the object then the balloon is inflated and the catheter is pulled out, dislodging the foreign body.

“People don’t really have a good grasp of the anatomy of the nose, because a lot of people think it’s just like a tube,” Scholes said. “It’s a big cave once you get past the nostrils. So once things get back far enough, you kind of lose them.”

For parents whose children have put things up their noses: Scholes said such objects rarely move much and can generally wait until an appointment the next morning. Having the object removed without the ER facility fee will be cheaper.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.