Bleeding Green: Modern Bloodletting

This documents a 2007 visit to a California hospital Emergency Department by a college  graduate student with health insurance. The student’s insurance policy, provided by a major university,  states that ‘Emergency visits are covered, 100 %, while outpatient visits carry a 20% co-pay’.

I “What led you to seek emergency care?

U ” I had a pain in my chest, a tightness that made breathing painful, and I was short of breath. I couldn’t get enough air, and became dizzy, light headed.

I ” Had you ever noticed this before?

U ” Sometimes, but it cleared up shortly by itself.

I   ” I understand your health is good, you take no medications, have had no significant illness other than hay fever, and some asthma as a child.

U ” That’s right. I sometimes have taken antihistamines for allergies, but none recently. I use an albuterol inhaler at times, and tried tonight that but it didn’t help, and I wasn’t wheezing anyway.

I  “  So you went to the E D. Did you drive?

U ” My husband took me after we checked our insurance and found we were covered for such things, in an emergency.

I “What happened at the hospital?

U ” They took me in fairly quickly, started an I V and oxygen, did an EKG,  and drew some blood for tests, checked my oxygenation, and gave me some albuterol by a  hand held inhaler that they supplied. I told them I had tried my own inhaler at home without any effect, and was sure it was not empty, and offered to use my own, but they said I couldn’t do that in the E R. They sent me for a Chest X-ray, and I was returned to the E D.  After about an hour the Dr. saw me and listened to my lungs and heart.  I thought it was the doctor but later found out he was a nurse. He said the lungs were ok, and my cardiac enzymes were ok, and my X-ray; but my blood pressure was slightly high, and my potassium was slightly low. So he wanted to do a CT Scan.

“I asked why, and what that might cost. He said it was a precaution because of my abnormal blood pressure, and potassium test. He said the cost of my ED  care was covered by my student insurance, and it was important to do the CT in the E D, right then;  to do it  later as an outpatient, when it would cost me more.

I ” Did he say anything more, like what he suspected?

U ” No. But my father is a doctor, so I asked the E D Dr. to speak with him before sending me for more tests. I gave him the phone number, and he called my dad. Afterward the Dr. said my dad agreed with the tests. So I went to C T.

” Did you talk with your dad?

” No, just the E D Doctor. But afterward, my dad said he had questioned the need for the C T, feeling that I had chest discomfort from over-breathing; a common condition that some people can experience when stressed or worried.  He thought my very slightly high blood pressure may have been due to the situation and the albuterol and anxiety. He explained that the E D doctor was concerned about a renal cause of high blood pressure and abnormal potassium. My dad told the doctor that it seemed very aggressive to resort immediately to a CT scan. However, my dad felt that since he wasn’t there, he should defer to the Dr who was there.  I was ok by then, no more chest pain.  So I had the CT and went home with instructions to call for a follow-up appointment with an internist.

“The internist got the CT report which showed a 1 cm nodule in my left kidney. She felt a number of other tests needed to be done, some 24 hour urine tests, and blood tests, which I did. But when I returned for the results, she said she couldn’t decide what to do next, so sent me to another doctor, an endocrinologist. The endocrinologist said the tests that had been ordered were wrong because I had been given a diuretic by the emergency doctor, and ordered some more, tests including more 24 hour urines. After all that the Dr. said there was no significance to the tumor; it was probably  benign.  All the lab findings, and my blood pressure were normal.

I ” But the tumor?

U ” .  The endocrinologist said no treatment was needed, except to get a CT Scan of the kidney every year or so. He said almost all of these small kidney growths are of no significance, and there was no other evidence of an endocrine problem related to blood pressure.

I ” How’s your blood pressure?

U  ” Fine. I take it myself at home. I am to take a 12.5 mg.  hydrodiuril if it is over 130/80, but that rarely happens.

I ” Well, except for the time lost, and the run around, and the Radiation exposure, it seems like all is well.

U ” Not really. I spent many hours going back and forth, and sitting in waiting rooms.  Now I’m being billed by the hospital for all the tests and the E D visit as well. They explained that the 100% ED coverage is for the Emergency Care but not the tests, labs, Xrays, CT or medications. I have tried to object, explaining that the coverage as described seems almost deliberately misleading. But they say that is their policy.

I ” Do you have an idea what the charges were for your care?

U ” More than $7000, and my bill, the part the insurance did not pay, was  about  three fourths of  that. They explained that emergency care meant only the visit to the emergency room, not the lab, Xray, consultations, or special procedures done while I was there, nor when I was seen afterward in follow up visits.  The CT scan, and Xray aren’t in the emergency room.

I ” What are you supposed to do if your symptoms return?

U ” Return to the emergency room, or call 911.  But at this point I’d rather die first. I suppose then my care would be free or  at least noncollectable.

I ” And the CT scans?

U ” Are you kidding? Not without good reason, other than to pay for the scanner.  Do they expect to  burn the benign tumor up with radiation?