The Carmodys are part of a growing underclass known as the "working poor." They don't earn quite enough to afford medical insurance, but make too much to qualify for the Arizona Health Care Cost Containment System, the state's healthcare program for indigents. So, they had been paying out-of-pocket for Tammi's prenatal care and delivery package at Phoenix Memorial Hospital.
By scrimping and saving, the couple completed payment of the agreed-upon fee of $2,195 a month before Tammi went into labor. However, because of a physical complication and an inflexible financial officer at the hospital, the couple's bill ballooned to more than $9,000.
The Carmodys have no beef with the care Tammi and their new son, Austin Christopher, received at Phoenix Memorial. But even if they had had the money, they say they wouldn't have agreed to pay the unexpectedly large new bill, which the hospital sent to them August 11.
"I just don't think that what Phoenix Memorial did to us is right," Tammi Carmody says.
Both in their 20s, the Carmodys moved to Phoenix from New York after the birth of their first child, 2-year-old daughter Ashley. Chris Carmody found work with a small pest-control firm, while Tammi worked part-time for a Valley attorney.
After Tammi learned she was pregnant late last year, the couple looked carefully for a hospital and a midwife.
"I wanted the tender, loving touch of the midwife along with a hospital that could take care of things if something went wrong," she says. "I had had a beautiful experience giving birth [with a midwife] in New York, and I wanted it to be just as beautiful here in Arizona."
The Carmodys settled on Phoenix Memorial, which has the Valley's only certified midwifery service. They signed a contract that demanded $2,195 payable a month before Tammi's estimated due date. The sum was to cover prenatal care, normal lab charges, childbirth classes, a six-week postpartum checkup, labor and delivery expenses, and the services of a midwife, obstetrician and pediatrician.
The contract listed "complications" which would void the $2,195 package, including a "Caesarean delivery and all related charges." Austin was a breech baby, which necessitated a C-section.
Fortunately, the procedure went perfectly for the six-pound, six-ounce newborn and his mom.
"The nurses worked their butt off that night making sure I was okay," Tammi says. "And the surgeon [Dr. George Davidson] and everyone else was very professional. The people were good to me."
After Austin's birth, however, a new set of complications developed. A Phoenix Memorial financial officer showed up in Room S215, where Tammi Carmody was nursing her newborn.
Tammi says the bill collector offered her a $3,000 "Caesarean Package Agreement," payable in this instance within 30 days after she went home with Austin. She adds that the officer didn't indicate whether any portion of the already-remitted $2,195 would be applied to the new fee.
"She said she needed $1,500 down before I left the hospital," Tammi says. "If I didn't come up with that amount, she said I'd get an itemized bill. She said I should borrow the money from my family, or use credit cards, whatever it took. She brought me to tears. I had showed good faith during the whole pregnancy to meet our obligations, but I knew we couldn't come up with that kind of money."
An eight-page, itemized bill from Phoenix Memorial arrived August 11, a week to the day after Tammi went home with Austin. The new bills for mother and son totaled $9,147.60.
The hospital charged the Carmodys for everything: Two packets of four towels each cost $75.80. A "maternity kit"--freebies of infant odds and ends such as rubber nipples and product samples, provided to hospitals by manufacturers--cost $125.50. A pair of surgical gloves cost $7.35. And so on.
In an interview, John Nimsky, Phoenix Memorial's vice president for planning and marketing, said Tammi Carmody may have "misunderstood" the finance officer, whom he declined to identify.
"My understanding of how things left off," Nimsky said, "is that the patient was asked to go home and think about how she wanted to pay the bill--that monthly payments could be worked out. We do that all the time. But our records show that she didn't respond, so we itemized."
Surprisingly, Nimsky added, "If Mrs. Carmody will call us, we're prepared to go with monthly payments." Nimsky said Phoenix Memorial is willing to give the Carmodys credit for $1,571 of the $2,195 the couple originally paid.
Tammi Carmody was relieved to hear of the hospital's proposal. However, she adds: "It's like, New Times gets onto the story and the hospital starts caring. If [the finance officer] had said that from the start, it would have been a done deal. But she laid out the options--$1,500 by the time I left the hospital or else. That was it."
A few days after that interview, Tammi Carmody tells New Times she had called Phoenix Memorial's Nimsky to discuss matters.
"The bill is now down to $1,300 and we can pay month by month," she says. "That sounds fine with me.