Archive for July 2010

Better Safe And Sorry

If you’re a man who happens to be age 40 or over and you experience chest pains, do not dilly-dally, they say. Go immediately to the Emergency Room. This is not a drill; this is the real thing.

Health care industry workers take this particular symptom so seriously, in fact, that one time years ago, well before I was 40, I called my Primary Care Physician about a digestive issue and as soon as I mentioned feeling something — anything — in my chest, the nurse urged me to hang up and dial 911.

I’ve suffered from dyspepsia, reflux and a host of related upper-gastrointestinal issues my entire adult life, and as a result I’m intimately familiar with what it feels like to have simple, or even severe, indigestion.

So in May when I felt some discomfort in my chest that was unlike anything I’d experienced before, I panicked a bit. I’m not overweight, I don’t have high blood pressure and I have no real family history of cardiac disease, but I don’t live the healthiest lifestyle, either, and I’ve been a cigarette smoker for the better part of 17 years.

With that in mind, along with my age (40), I decided I should heed conventional wisdom. As it says in one of the medical books I pore over frequently (because, let’s be honest, I’m a bit of a hypochondriac), “Any adult who suddenly experiences discomfort in the chest must assume that it has something to do with the heart and act accordingly.” So off I went.

I drove up to the ER, walked inside, approached the check-in window and began explaining my situation to the woman behind the counter. Now, I work in a newsroom where we’ve grown jaded and unimpressed by ordinary events, such as murder, violence and corruption, so it’s only when something truly remarkable happens — say, a gunman is holding a hostage in the local elementary school parking lot, or a tanker explodes on the freeway killing two police officers — that we really even bother to wake up. In those rare electric moments, you can literally see a palpable energy spreading across the room like “The Wave” at a football game. When I uttered the words “chest pain” at the ER check-in window, I felt the spark of that same energy and watched as it flashed across their faces and shot through their limbs. Suddenly the room was all abuzz, and its meaning was clear: “Holy shit, we’ve got ourselves a bonafide emergency!”

I was fast-tracked to the ER. “We can fill out your paperwork later,” said the nurse who escorted me urgently to my bed. Without delay, another nurse hurriedly began hooking me up to everything in sight. Electrodes were attached to my chest and an IV was jabbed into my arm. My heart rate and blood pressure were checked. Blood was drawn. A chest X-ray was taken. An electrocardiogram was performed. My condition was stable.

Thirty minutes later, a doctor shuffled in. “You’re fine,” he said. He suggested it was indigestion. I respectfully disagreed. He recommended an endoscopy. I took it under advisement. He sent me on my way.

And that, more or less, was that. I trusted conventional wisdom. I consulted a doctor. I explained my symptoms and I was whisked away into a whirlwind of health care procedures that, presumably, were in my best interest. And then I was given a clean bill of health, or at least a reasonably clean one, and dismissed. “Nothing to worry about,” was the verdict. Who was I to argue? The doctor knows best.

Sure enough, within a few hours, the weird pressure in my chest was completely gone. “I guess I’m fine, after all,” I thought. “Awesome!”

And it was. Except …

Two weeks later the bills started showing up. Bills. Plural.

I got one from the hospital itself for $623. I got another one from the doctor I saw for $89.54. I got a third from my Primary Care Physician for $25. I got a fourth from another doctor for $27.64. Total cost out of my pocket: $765.18.

The kicker? None of them — not one — really explains exactly what it’s for. “Services rendered,” one says. By comparison, another that reads “Emergency visit” is acutely specific. Other charges listed on my various bills include “Drugs,” “Laboratory” and “Emergency Room.”

Now, I’m the first person to admit that I don’t know shit about how health insurance works. But this seems unnecessarily convoluted and (intentionally?) inscrutable.

I was there for less than an hour. I saw two nurses and spoke to one doctor. I did as I was told. I trusted them.

I have health insurance through my employer, and from what people who know about this stuff have told me, my coverage is pretty good. I realize a trip to the ER isn’t exactly “preventative” care, but considering the circumstances I’d think this would be something that would be fully (or, at least, mostly) covered.

Each year, I pay over $1,000 before taxes out of my paycheck and my employer graciously contributes something like three times that amount. In exchange for that, I get “coverage.”

What does “coverage” mean? I don’t have the slightest idea. But what it appears to mean is that my employer and I make a substantial “loan” to an insurance company, and then if I get sick they go ahead and put that money toward the parts of my bills that they find agreeable and then charge me for the rest. But if I don’t get sick — or sick enough, anyway — they simply pocket the change.

I’m sure it’s more complicated than that. I’m certain of it. What I don’t understand is why.

Why am I paying money to doctors I never saw? Why am I getting four different bills for one ER visit? Why are there 19 different nebulously designated items on my various bills? And how much of these unexplained costs are the result of nothing more than the fact that we’ve created a system that is needlessly complex?

I don’t have any answers for any of that. Like I said, I’m clueless about this stuff.

But here’s one thing I know: Given my current financial situation, if I experience severe chest pains tomorrow, I hope it’s no big deal because I’m not going to the ER. I don’t trust the system anymore. I don’t trust conventional wisdom.

The same book I referenced above goes on to say, “If it turns out to be a false alarm, you’ve lost nothing. But if it indeed was the heart, you may have saved your life!”

True enough on that last count.

But the first part? Not so much.