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Triple Digit Copay

October 21, 2019 pm31 9:48 pm

I’m ok. But I wasn’t sure this past Saturday.

I hadn’t eaten much, just snacked. Walked to a grocery store – long walk, 2 miles each way, for some exercise.  When I got there, I felt a twinge. Figured it was from not eating. Went away. I shopped. And going home the twinge was back, a bit more insistent.

Got home about 7:30. It was hurting. I ate, thinking it would clear itself up. But no. Badly upset stomach? But aside from the food I just had, my stomach was empty. I tried watching some tv to take my mind off. Couldn’t focus. Tried the bathroom – nothing was helping. Hospital? That’ll be $150, could be for nothing. I’ll wait an hour, I told myself, and if it doesn’t clear up – the hospital. Five minutes later I couldn’t wait, and walked up the street.

As I walked I made a mental note of all the extra steps that were being counted. The pain surged and ebbed. But now, at the low end, it was still a “5” on the 0 – 10 scale. And the high end was getting worse. Had I waited another half hour, I don’t think I could have made the walk.

The wait wasn’t too bad. There’s a process that kept engaging me with a new person every few minutes. Registration. Then a little wait. I couldn’t sit still. But my pacing was making people nervous. I stepped outside. Then I got called to triage (it had a different name). That was before going to the Emergency Room. Then another quick interview to put me in a category. I think mine was “abdominal pain.” Then a clerk with waivers. Four signatures. I had trouble signing.

And then the Nurse Practitioner, who was patient and kind. In the exam area she asked questions. I asked something I’ve never asked before – can I have something for the pain? It was spiking near a 9. I was nauseated. I almost passed out. I was breaking cold sweats. She put an IV in my arm, without drugs, so that it would be ready when they decided which pain med to give me. She also pretty quickly determined that I probably had a kidney stone.

The IV drip changed the night. It took only a few seconds to drop the pain, a few more to bring it to a 1, and then 0, and I was pain-free for the rest of my almost 14 hours in the ER. I waited patiently for a CAT scan. There was extra waiting, because they had scheduled “downtime” for their on-line system – somehow that makes sense to do, but I can’t see how.

And then it was 1:30. And I sat in the Emergency Room, and waited for results. I tried to drift off. But ER. Beeping. Noise. And now the guy who was moaning and screaming before (I was in too much pain in the previous paragraph to make a note) was playing music, loud music. I asked, not trying to look sad, but succeeding all the same, if there were somewhere, anywhere… And someone took pity (maybe the NP) and sent me to the exam area, where a curtain provided a modicum of a barrier but not much. But the exam table leaned back, and I used my jacket as a hood and a pillow, and got almost coach class quality sleep – maybe an hour and a half over the course of the next 2 and a half.

I came out. A nurse brought me two pills. I was confused. One was for prostate function, the other an anti-biotic. I took them, and was ready to look for the NP, when she found me first. The kidney stone was on the CAT, and small enough to pass, but was obstructing something, it looked like I had an infection. The “prostate” med was actually to flush the stone, and the antibiotic for the infection, but the stone might need to removed. That day. She took my weight, and asked about the last time I had eaten. This was for the anesthesiologist. They were serious.

Urology had some concerns. They were not positive. And they ordered more blood work (one number was way off when I came in). A urologist came down. She said it might be surgery, it might be another one of two uncomfortable sounding procedures. She was waiting for blood work. And she noted that I had not had a fever, and asked me to go back through some details. She noted that my pain had not returned. And then she left. I alerted some friends and relatives and work about what might be in the cards.

And I waited. The shift changed. I got on a stretcher, and got wheeled into a curtained bay. I saw a doctor. I told him what I was waiting for, but he already knew. And then he came back. The white blood cell count was better. He hadn’t seen the number. Urology was considering the non-surgical interventions. And maybe 45 minutes later he came back. The number was way down. Well within the normal range. I should take ibuprofen and lots of water and the two drugs I’d already started, and I could go. Home.

So it’s not done. I have to get rid of this stone. But I was being set free. Wait – ibuprofen? Will that do it?  Whatever was in the drip last night, that was great stuff, brought the pain from 9 to 0 in no time. Turns out, it was a close relative of ibuprofen. No more questions. I was ready to go.

Last stop, Discharge. Turns out, I have a copay. I knew it. If they admit you, the copay is waived. If they don’t, the copay’s a buck fifty. Why should NOT having surgery cost over one hundred dollars?

This is a “health care cost savings” agreed to by my union. The high ER copay supposedly is to discourage frivolous use. But you read my story. What was frivolous? Could TelMed have visualized the stone, or the build-up in the kidney? Where else could I have gone to get my abdomen examined? To rule out appendicitis? Should I have gone to Urgent Care (only $50, I think) to have my vitals taken? I almost passed out from pain. Saturday night. Could I have waited until Monday to call my regular doctor?

I only thought for one second about the copay. How about a beginning teacher, with debt? Is the copay high enough to discourage someone at the bottom of our pay scale from making a medically necessary trip to the Emergency Room?

How about we stop calling health care concessions “cost saving changes” and start calling them “life threatening changes”? And then how about we stop making them.




18 Comments leave one →
  1. Michael Morelli permalink
    October 21, 2019 pm31 9:58 pm 9:58 pm

    Agree completely about the copays. I am one of the lucky ones that has a secondary insurance that takes care of the copays. They just keep on going up. I personally wouldn’t mind paying a fraction more a month for the insurance to reduce the copays for everyone.

    • October 21, 2019 pm31 11:49 pm 11:49 pm

      No one should have to think about cost when deciding whether to seek health care.

  2. Arthur Goldstein permalink
    October 22, 2019 am31 7:45 am 7:45 am

    $150 is not something anyone should think about when deciding to seek health care. A musician friend of mine who’d have been on the hook for thousands decided not to go and died the following day. That’s the crisis, and the cure is a national program. I don’t like paying the 150 bucks either, but the alternatives are far worse. A national program will relieve pressure on the union.

    • October 22, 2019 pm31 8:13 pm 8:13 pm

      I remember not so long ago, you and me urging members to vote no on the concession that turned into these high copays.

      • Arthur Goldstein permalink
        October 25, 2019 am31 7:48 am 7:48 am

        I remember it being 2014, which is five years ago. I had to go to the ER a few weeks ago, and I’m very grateful to be able to easily afford it, unlike millions of Americans.

        • Michael Morelli permalink
          October 25, 2019 am31 8:11 am 8:11 am

          Agree 100%.
          As I said previously, I am one of the lucky ones with two insurances.
          With all my medical appointments, the copays would have really hurt me.
          Because people can’t afford preventive care, it costs the rest of us more money due to the costs of long term care for the terminally ill. Not to mention the slow painful dying that goes along without having preventive care.

        • October 25, 2019 am31 8:11 am 8:11 am

          I too am grateful. We are both fortunate to be able to easily afford a $150 copay. Not all of our paras and new members are as fortunate.

          If there’s another attempt to raise copays, or force more members into HIP, we will have to raise our voices again. I hope that does not happen.

        • Michael Morelli permalink
          October 25, 2019 am31 8:33 am 8:33 am

          The newer members have been totally shafted. I always hated that attitude of me first and screw the new guy/gal.
          The principals did it and I remember when I first started teaching over 35 years ago, it happened to us.

  3. Arthur Goldstein permalink
    October 26, 2019 am31 10:01 am 10:01 am

    The only solution to this issue is going to be some form of nationalized health care. It’s an abomination that we’re the only non-third-world country without one.


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