Monday, December 30, 2019

A Short Visit to the E.R. on Christmas Eve

I woke up a little after midnight with a pretty intense pain on the right side of my stomach. I'd felt something earlier in the evening but thought it was maybe just gas.

I snuck out of the bedroom Mrs. Done by Forty, Baby AF, and our dog, Cayenne were all sleeping in while visiting my in-laws, and crept into the bathroom to, um, validate whether or not it was just gas. It was not.

I managed to ignore the throbbing and get back to sleep, but then the pain woke me up again around two in the morning. I started googling and it seemed like I might have appendicitis.

So I called the two urgent cares that were open in the middle of the night in San Diego. Turns out neither would be able to help: they'd need to do a CT scan and neither had that equipment. Both places recommended I go to the E.R.

I knew that could be costly: really costly, because the insurance I'm on, in addition to being a high deductible health plan with a whopping $3500 deductible, there's a catch where if you go to an emergency room and the insurance company deems it was not a true emergency, then I'd have no coverage at all.

I've actually seen what a hospital bill looks like before insurance works its magic and its pre-negotiated rates, thanks to an earlier dispute with a hospital when Mrs. Done by Forty went in for bad food poisoning. It's not pretty. Thankfully the insurance company ended up covering the visit in the end but, for a while there, it looked like we were going to have to pay something like $27k for a visit to the ER, and one night in a hospital.

Sure, I was in some real pain, but did I want to roll the dice with that kind of bill?

By this point I'd woken up Mrs. Done by Forty, who was whispering to me to go to the E.R.: the urgent care nurses thought it might be appendicitis, as did the nurse-line I called to, but there's really no way of knowing without actually going in and seeing someone.

I finally decided to call a Lyft and go in to the hospital. No sense having Mrs. Done by Forty wake up Baby AF and all of us go in, and I didn't want to wake up my in laws, either. The Lyft driver saw the destination and couldn't have been nicer to me. (While I have some mixed feelings about ride share companies, I've found the workers to be courteous, genial, and reliable: just a treat to interact with.)

When I got to the front desk at the E.R., I was describing the pain I was in to the nurse and he asked for my insurance information, and I asked if it made more sense to just wait until more urgent cares were open in the morning.

"Why would you want to wait though?"

"Well, I have this HDHP with a high deductible."

"How high?"

"It's $3500, and then they start paying 80%, but the out of pocket maximum is like almost eight grand. Depending on what we do here, I could be looking at that."

"Wait, what?"

"Yeah, it's actually worse than that now that I think of it. If my insurance company thinks this wasn't a true emergency, then they won't have any coverage at all: I'll be responsible for the whole bill. Think I should just head to an urgent care at 8 or 9 am? I bet a couple are open on Christmas."

"Show me again where you're having pain."

I pointed to the spot, underneath my rib cage on my left side.

"That seems high for your appendix."

One of the other nurses waved me to the exam room, "Come over here for a second," she said.

She asked me to lay down and pressed down on my stomach, asking where it hurt.

"I think it might be your gallbladder. You might have gallstones. Did you eat a lot of fatty foods today?"

And then I thought back to the California burrito from lunch. The one that had to weigh over a pound.

Filled with carne, french fries, sour cream, guac, cheese, and all the hot sauce.
And then I thought about the tamales I had for dinner. And the cheese plate we had after dinner. And the eggnog.

So yeah, there was maybe some fat.

They said I should get it checked out with my primary care physician if the pain went away, which it should, or I could go to an urgent care in the morning if any were open. 

After feeling kind of embarrassed, but mostly just grateful for the generous staff that was willing to spend a couple minutes confirming I didn't need care right then, so that I wouldn't have to potentially spend a few thousand, or potentially tens of thousands of dollars, on a hospital visit my insurance wouldn't pay for.

On the way home, I had a lot of emotions. Still in some pain but glad to know it should subside in a bit, I felt grateful, lucky to have met some kind people in the ER.

Then some guilt, as I realized a nurse had performed some unpaid labor, only a couple minutes but, still: work they'd typically be paid for. If the staff knew our net worth I suspect we wouldn't have gotten a freebie. I didn't give the impression we were hard up for money, but I also didn't come right out and say we were wealthy, either. Maybe I should have. 

And then, as I tend to do, I shifted to thinking about this weird health system that we have: a system where your insurance won't pay for ER visits unless they're truly emergencies, but you often can't tell if it's an emergency until after you speak to a medical professional. A system where the ER might be the only place open on a holiday that has the equipment necessary to diagnose you, but then will retroactively say you didn't need the test or the visit to the ER, so the cost is on you.

We, of course, are able to navigate this system and pay for its costs, better than most people. I wonder how that night would have gone for someone who didn't have insurance, or didn't have a big old pile of money.

I suppose this is a good place to disclose that I work for an insurance company and, as you might imagine, the same one who insures us. I have mixed feelings working for this industry: one that certainly helps Americans avoid bankruptcy from medical bills and negotiates with providers to keep costs down. But then there's the pesky fact that they also lobby to keep this messed up system in place, one that is perhaps acceptable for high earners or those with government benefits, but is immensely difficult and ridiculously expensive for so many others.

I sometimes, albeit rarely, feel a certain amount of pride working for a health insurance company. Since medical bills are the leading cause of bankruptcy in our country, I like the idea that our company helps combat that: we help absorb those costs, and help keep them down in the first place via contracted rates.

But insurance companies also deny claims that, in the eyes of providers and patients, ought to be covered. We cover certain medications, but not others that could potentially save a life, if only it would be paid for. And we create a system of coverage so difficult to navigate that patients avoid care to ensure they avoid bankruptcy.

The whole experience has me ready to leave this field. FIRE, for all its flaws, is giving me the option to leave a company and an industry that I feel less and less connected to each year; one harder to justify as an organization I give so much time and effort to every day.

To what end? To save a behemoth company a few million extra dollars?

To save up more money for ourselves?

It's getting harder to answer the 'why' of this job of mine. Which is okay, I guess. In the meantime, we have bills to pay and goals to save up for, so the paycheck is nice. I shouldn't complain.

But when we have enough, when my spreadsheet and my gut say it's time to go, I have a feeling I'll be ready.

*Photo is from Alverice Moon at Flickr Creative Commons.

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  1. Using healthcare can be so stressful with how complicated billing can get. All of the healthcare workers deserve a medal for being able to help people while also trying to manage costs for people. I've been saved so many times by having a close family member who is a doctor who gives me unpaid advice kind of like the nurses in your story.

    1. Agreed on the medical professionals deserving a medal, Shnugi. It takes a special person to work in that field.

  2. Man, I was getting anxious just reading this. The choice on if you should seek medical care or not can be the difference between life and death - or apparently between a burrito and a burst appendix -_- Glad to hear it worked out!

    1. I'm glad it worked out, too, Adam. I was feeling some anxiety that night, too. :)

  3. Overseas we are covered by work health insurance ... back home in Canada it is free ..... hmmm

    1. Canadians definitely have it much easier when it comes to healthcare. You all have a far better system.

  4. This sounds like a terrible situation to be in! No one should have to decide whether or not to run diagnostic and possibly life-saving tests because their insurance might not cover it. As an American who moved to Canada a few years ago (for unrelated reasons), I definitely do NOT miss the US healthcare system. If I ever do move back it will probably not be until healthcare is more stable and less of a mess.

    1. Neat that you moved to Canada, EfficiencyNerd. Was it a difficult transition from an administrative standpoint? We've considered moving abroad but have found that most of the time it requires us to work while we're there, which doesn't align with our plans all that well.

  5. The whole health care/health insurance is ridiculous. It's crazy that you had to even contemplate whether to go see if, you know, you could possibly die from your appendix bursting. Glad to hear that it wasn't anything more than your gall bladder telling you to not eat all of one day.

    1. Ha! Yes, I need to learn to spread out my fatty meals better. Am able to see my primary care doctor fairly soon so hopefully she can give me a plan to deal with this (hoping to avoid surgery).

      And yeah, this whole system is ridiculous.

  6. You know my thoughts on the American medical system. I'm so glad you're okay and didn't get stuck with a huge bill.

    As for the guess is that she's likely paid an hourly rate, regardless of who she sees, so you probably didn't harm her at all.

    1. Good point on the hourly rate, Frugalish! That does make the unpaid labor point a bit easier to swallow.

  7. I'm glad you're ok. That sounds really stressful and another reason why we're sticking with regular insurance for now (not HDHP.) When we need to move to HDHP, we'll deal with it. The healthcare system is ridiculous. My dad lives in Thailand and he doesn't have to worry this much. He can just go to the ER when he needs to. There are other hoops to jump through, but it still sounds a bit better than here.

    1. We might consider switching back, though the point about emergency room visits not being covered in 'non-emergencies' applies to ALL our work plans, regardless. :/

      The system in Thailand sounds way more logical, to me. Glad he has that option.

  8. Honestly, this nurse could be sued by a patient, lose her license for practicing medicine without a medical license, or even just fired. I strongly suggest you change your current insurance. Life and medical problems happen. You have options. Many people don't.

    1. Gosh, sad state of affairs really. That a nurse could lose her licence... ultimately for using her knowledge and experience, which is different but valid.

      Honestly, as a non American, the US medical system terrifies me!

  9. I'm so glad that you didn't have appendicitis. I had pain similar to you last holiday, with massive sweating and it lasted for days, so after emailing with my doc a few times, we finally ended up going to the ER ... and it wasn't anything we could figure out. I was so mad and I wasn't even out a lot of money. Our ER visits are $100. I just hated wasting a bed and everyone's time but I had no way to know if it was or wasn't an emergency, I had waited days already.

    We REALLY need a pre-ER step where we can get checked to see if it really IS an emergency.

    In your shoes, I'd try to send a big semi anonymous but vague thank you GC to the nurses who helped you out if that was possible.

    1. Love that idea for a pre-ER step, Revanche. I feel like urgent cares are doing this in a way.

      Great idea on the thank you note, too. Getting one of those written today.

  10. well, from one side, yes medical and health insurance system is messed up. From other side, you want to be done by forty on account of other people. This would bother me. Like, look at me, - I am frugal, don't pay for my insurance coverage, but ask ER to check me. And you can afford it.

  11. I had a similar experience when I needed stitches on a state holiday. None of the urgent cares would be open for about 15 hours. The cash-based place I use would have charged a flat $125 and I would have been in and out in under an hour. After considering sewing it up myself and googling the potential consequences of waiting it out, I relented and went to the ER, where it took 5 hours to get some pretty mediocre stitches (gnarly scar) and cost $2500 after insurance adjustments ($10K high ded plan). Lesson: Don't demo your bathroom in shorts on a holiday. Wait until the next day.

    1. Oh, man. That sounds like a tough holiday experience, Em.

      That sort of ER bill is exactly what I was worried about, with an extra side of anxiety that it wouldn't be covered at all and I'd get the unadulterated ER bill sans insurance. :/