What happens when you get hit by a car in San Francisco

When I woke up in a pool of my own blood and teeth on Arguello Boulevard in front of Temple Emanu-El, I thought: “It’s curtains.”

I was near the end of a 100-mile bike ride, as part of my training for an Ironman competition, when I was side-swiped by a pickup truck that suddenly veered into the bike lane. I landed face-first on the asphalt, crumpled beneath my bike, my mouth crushed into the ground. 

My mom died two years ago — she was on a morning walk with a friend, said she felt lightheaded, then dropped dead on the sidewalk. I’d thought a lot about death since then, and as my consciousness slowly flickered in and out, I thought maybe I’d joined her. 

But when, dazed, I regained my vision, with the world madly spinning, I realized I had narrowly survived, only to find myself at the starting line of a journey I wouldn’t wish on my worst enemy: a slog through the American medical and insurance systems.

The six months since I was hit have been a master class in institutional indifference. Getting mowed down by a truck was just the opening act. I’ve been wrongly billed hundreds of thousands of dollars for the privilege of not dying. I’ve discovered that health insurance companies have legal dibs on any money I might recover from being maimed. I’ve learned that the driver who rearranged my face would face fewer consequences than if she’d parked at a red curb. And through it all, I’ve encountered a medical system so burned out that basic decency feels optional. 

To be clear, I’m fortunate: I survived. And I could afford the co-pays, the lawyers, the time off work. I knew which calls to make and which forms to file. Others in similar circumstances don’t have that support, and many face financial ruin and inadequate, if any, care. I’m telling my story most of all in hopes of improving the outcomes for people who start off in a more precarious place. 

This is my experience of what happens after getting hit by a car.

Through the pain of the cracked bones in my face and the teeth that had been ripped out of my mouth, I heard someone on the street call out: “You’ve been hit by a car. Can you hear me?”

A woman crouched beside me, saying, “My name is Genesis. Can you tell me your name?”

I mumbled my husband’s name and pushed my phone toward her with hands I couldn’t feel. 

That’s when time started spinning: shouts, sirens, flashing lights, paramedics, my husband’s voice shouting, “Are you alive?” from outside the ambulance after my bike’s GPS alerted him that I’d been in a crash.

I arrived at the San Francisco General Hospital trauma unit covered in sweat and blood, dehydrated and depleted from a long bike ride. And with a mangled mouth, I couldn’t eat or drink. I spent a few hours in the emergency trauma unit with my head and body strapped to a gurney as I was taken in and out of CT scans so doctors could understand the full scope of my injuries. Eventually, I was told that I’d need surgery to screw the broken and depressed bones in my face back together. The first appointment was in a day and a half, so I’d have to stay the night. 

Shortly after, I was taken to an overnight room where, in the middle of the night, I desperately jammed the call button on my bed as vomit erupted through the gap where my teeth had been, while, outside my room, I could hear staff laughing about a new Netflix show. Later that night, nurses forgot my pain medication but somehow remembered to check my vitals six times. 

“Your potassium is 3.4!” a doctor announced on the second day, marching into my room to wake me with the news. Of course I had no idea what that meant, though a Google search days later taught me that I was just a hair below the acceptable range of potassium levels. But this triage team decided to make it an emergency. Minutes later, a nurse appeared with an IV that, despite the narcotics, felt like a wire hanger writhing through my veins. I started uncontrollably sobbing in my bed when a visiting friend came into the room and demanded an explanation. The nurse shrugged: “Yeah, I’m not sure why we’re doing this — it hurts like hell, and he doesn’t really need it.” 

Thirty-six hours passed before anyone offered to help clean me. I’d spent that entire time in my crusty cycling gear. On the second day, the surgeon who’d be bolting my bones back together came to give me an overview of the procedure. She saw me wincing in pain and asked if anyone had offered some ice for my face. When I mumbled “no” she rushed out of the room to get me some. 

After my surgery, two hospital administrators appeared in my room to photograph my wounds, apparently to document a completed job. 

“Hit by a car?” one asked. “Maybe you should be more careful next time.”

Once home, I wrestled with the hell of exposed nerves and uncontrollable drooling — I had multiple teeth cracked open and in half, and shards of broken tooth embedded in my gums. I needed to find and then get myself to an oral surgeon to fix that. Hospitals don’t do teeth, I learned. 

Every minute became its own survival game. I lost 15 pounds in a week. My body consumed itself while I survived on liquids squirted directly into the back of my mouth.

The day I returned home, so weak I could barely stand, my health insurer, Anthem, welcomed me with a bill for $187,000.

As CEO of The Standard, I always tell our team that one thing I’ll never skimp on is health insurance. Because when you need it, you really need it. At The Standard, we pay top dollar for the best policies available. In my case, the out-of-pocket maximum was $3,000. It made no sense that I was billed $187,000. But when I contacted Anthem’s 800 number, mumbling and grunting through my broken teeth, they insisted that the bill was correct and that my policy didn’t cover a single dollar of the procedures I’d had. 

Enraged, I guessed the email address of Anthem’s CEO and wrote to her, “Try putting yourself in my shoes. I came within an inch of losing my life, and your first real outreach to me is, ‘You owe us money.’ You have the billing codes to know better, even if you don’t actually care that I survived.”

Hours later Anthem’s “executive escalations” team — a group of people designed to respond to annoying and determined customers — replied. Suddenly, the bill was an error. 

To date, I’ve had more than 50 email exchanges with Anthem to sort out billing. When I submit a claim in the company’s app, it’s automatically rejected without explanation. To work around this, Anthem’s team gave me a template form that they promised would be accepted. But when I submitted it, I got another auto-rejection — the form was missing fields that the app requires for claim submission. I was later told I hadn’t read the fine print.

The true cruelty of American insurance reared its head months later: subrogation. That’s insurance-speak for “You owe us money, no matter what.” Any money I might get as a result of this accident legally must flow right back to Anthem. 

In my case, that money will come from my auto insurance policy, which has coverage for accidents caused by uninsured motorists. I get a lump sum from that policy, ostensibly to cover medical bills and other issues caused by my near-fatal crash. But I must send that money to Anthem. Had I won a large settlement in a lawsuit, the same rule would apply. 

In California, we’re “lucky” that the total amount an insurer can reclaim through subrogation is capped at one-third of the settlement (a “low” limit, thanks to state legislation). In some states, insurance companies can, and do, take it all. And don’t even think about trying to dodge it — insurers have propped up a cottage industry of subrogation collection agencies. They will find you, and they will get their money. 

This practice brings in tens of billions of dollars a year for insurance companies, turning personal injury settlements into a profit center. 

One stunning aspect of the subrogation process is that with a good lawyer, you can actually negotiate to decrease the payment amount. Pay money to make money. 

I contacted Anthem’s press office for comment on this story, again by guessing email addresses, this time for top brass in the communications department. I asked what would have happened had I not called the company out on the initial billing error — how many people don’t do that and assume they have to pay? What percentage of bills are sent in error? And then fixed? I was given no detail and was assured that Anthem is “compliant” with the law. 

I also asked about the company’s stance on subrogation. No comment. 

California, like most of the U.S., has, through a lack of enforcement, effectively decriminalized reckless driving. The penalty for driving without insurance, as was the case with the person who hit me, is just a fine of up to $200 — less than a parking ticket for stopping in a red zone in San Francisco. 

Fewer than 5% of drivers who injure people on the road face criminal charges. Unless you’re drunk or flee the scene, you can destroy someone’s life with your vehicle and face fewer consequences than if you’d parked in the wrong spot.

Feeling rejected by both insurance and the law, I asked the attorney I’d hired to hunt down the phone number of the driver who’d hit me. I told him I wanted to call her. 

I wasn’t entirely sure why. At that point, it felt like I had just been shouting into the void for weeks, and maybe I wanted someone else to be on the receiving end.

When I eventually got the driver who hit me on the phone, she apologized profusely while claiming ignorance about my injuries. I said, “Really? You saw my bloody face and teeth on the ground and thought everything was OK? I don’t believe that.”

I pressed her for details on her life and why she was driving so carelessly and learned that she’s a young mother with little money who lives in the Central Valley. She was taking her daughter to receive specialized medical care in San Francisco because hospitals here have programs for low-income families. She was in a hurry to pull over and didn’t see me. She thought she had auto insurance because she “paid a friend for it.” The policy number she gave police the day she hit me wasn’t legitimate — but somehow no one noticed that at the time of the accident, so she won’t face a penalty for driving uninsured. 

I was stunned. I told her I wanted to meet in person so she could apologize to my face. I told her I needed that to move on.

We met a few months later, sitting uncomfortably across from each other at my attorney’s office as I played back security-camera footage of the collision. Tears started flowing down her face.

“Tell me what happened,” I said.

She explained that as she was driving down Arguello, a warning light had appeared on her dashboard and, because she had kids in the back seat, she pulled over suddenly and didn’t see me approaching her rear.

I’d rehearsed this meeting a million times in my head, imagining I’d puff up my chest and find a way to assert my self-righteousness. I thought I’d explain the ruinous consequences for her if I sued. 

But after she explained and apologized, she kept crying, and I just felt depleted. 

In the months since the accident, I’ve been so maddened that I’ve repeatedly felt called upon to pick up the pitchfork — to publicly clamor for stronger penalties against uninsured and unsafe drivers, for greater clarity on health insurance claims, better hospital conditions, safer bike lanes. I spun that energy into a frenzy of meetings with bike safety advocates, state legislators, and attorneys. Could I help them pass a law? Raise money for better bike lanes? Go toe-to-toe with the insurance companies? 

The short answer to all of those questions is yes. But the real answer is something more like: There’s me, and then there’s the machine, and the machine doesn’t get tired.

In the end, I’ve chosen not to sue the driver. It feels futile and unfair to spend time and money just to get a piece of paper that says I’m right. Anthem has gotten its cut through subrogation with my auto insurance. My dental surgeries will stretch another two years, each insurance claim a new battle with Anthem’s rejection algorithms. I’m not sure if the driver will be fined, though I do know she still has a driver’s license and was somehow able to get an actual auto insurance policy. 

As for Genesis, the woman who came to my aid at the crash site, I found her on LinkedIn and invited her to lunch. I told her that was the least I could do to thank her for helping me. 

Of everything I’ve done to create a sense of closure, that lunch was the closest thing I’ve felt to real finality. In 10 minutes on Arguello Boulevard, Genesis showed more care and compassion for me than every institution that followed. That’s a silver lining. It’s also an indictment. As far as I can tell, the system has worked exactly as designed: to protect business, not people.