She had felt this way before.

Last summer, an unrelenting bout of nausea had landed her in a hospital emergency room.

Medical professionals pulled out all the stops, pumping her full of fluids and running her through a battery of tests. Hours later, she went home armed with prescriptions to fight the nausea but no real diagnosis.

What had made her so sick? The experts weren’t sure.

Before long, though, the bill for her visit arrived in the mail. A few hours in the emergency room had resulted in thousands of dollars in medical costs. Her share, after the deductible, was more than $4,500.

She was still making monthly payments on that bill, and now she found herself back in an emergency room, again overcome by nausea.

The hospital staff quickly responded, checking her vital signs and providing liquids intravenously.

“A technician will be here soon to take you for some tests,” the nurse said. “The doctor wants to find out what’s making you so sick.”

The patient said no.

“I can’t afford that,” she said. “The last time I was in an emergency room, I left with a bill I’m still trying to pay. I can’t keep doing that.”

This time, even without the tests, the bill totaled more than $1,600. The patient found herself with yet another monthly payment.

This episode is far from unique.

National Public Radio’s Erika Stallings recently reported on a study published in the medical journal Health Outcomes. Researchers found that patients with high deductibles frequently delayed or skipped treatments they couldn’t afford.

Researchers reviewed claims data for more than 300,000 women whose employers had moved to a high-deductible plan between 2004 and 2014.

They found cancer patients with higher deductibles were slower to get diagnostic tests or expensive treatments such as chemotherapy. Other studies have found similar delays in diagnosis and treatment for complications from diabetes, cardiovascular disease and other conditions.

Stallings also noted a report in 2017 from the Kaiser Family Foundation that found 43% of adults with health insurance reported having a hard time meeting their deductibles. That was up from 37% two years earlier.

Dr. Veena Shankaran, co-director of the Hutchinson Institute for Cancer Outcomes Research in Seattle, told Stallings she was not surprised by the findings.

“We’re seeing that high-deductible plans are really the epitome of the access-to-care problem,” she said. “People don’t have the liquid cash to meet their deductible, so you see delays in care or even avoiding treatment altogether.”

Dan Klein is president of the Patient Access Network Foundation, a nonprofit organization in Washington, D.C., that helps underinsured patients gain access to medical care. He told Stallings he had noticed an increase in the number of patients seeking help.

“One thing that worries me is that Congress is very focused on lowering prescription drug prices,” he said. “That’s a good goal, but it’s meaningless in an environment where patients still can’t access care or medications because of their deductibles.”

And just for the record, these high-deductible insurance plans aren’t exactly cheap. Our patient in the emergency room has an employer-sponsored plan with an employee contribution of more than $6,600 a year. The employer pays almost twice that.

And yet she fears the bill she’ll get for a test that might help physicians figure out what keeps making her sick.

Weeks after that emergency room visit, she experienced yet another bout of nausea. This time, she managed to avoid the hospital.

Was this the same ailment as before? Or was it something else?

She’ll probably never know.

Kelly Hawes is a columnist for CNHI News Indiana. He can be reached at