Sam Danielson

On January 7, 2008 I had my appendix removed more than six weeks after initial symptoms.

I began feeling fatigued during a trip on Nov. 22nd. With symptoms of fever, extreme fatigue, and abdominal pain I called in sick and went home on the 24th. On the 26th I went to a primary care provider and was diagnosed with hematuria caused by a possible kidney infection or stone. I left with a prescription for seven days of steroids and ten days of antibiotics. Ten days later I still felt ill so I returned to the clinic where I again tested positive for hematuria and got a referral to a urologist. The urologist referred me to a CT scan where finally, on the 10th of December, I found the cause of my sickness to be an enlarged appendix. The urologist referred me back to primary care where I received a referral to a surgeon. The surgeon reviewed the CT scan and decided to remove the appendix but advised that since my condition was improving it would be best to allow some healing to occur before cutting. He prescribed some antibiotics and said it would be okay to work but agreed it would be best to consult an aviation medical examiner. The aviation doctor also said that I could work until surgery but cautioned me that I should not work with pain since it was a distraction. Since I was pain free for three days I returned to work on the 17th of December but the altitude changes and turbulence caused my abdominal pain to return. As should be expected the aviation doctor was right, pain is really distracting. I called in sick again and decided to wait until I had recovered from surgery to return to work. The surgeon did a great job and I have had less pain during recovery than I did during much of December. I don’t need pain medication but I have been using one dose at night to sleep through the minor discomfort of three incisions in my stomach. Finally, almost two months after beginning sick leave I will be fit to return to work. I have used the majority of my sick bank and filed for FMLA. What should have caused me to miss three weeks of work turned in to seven and a half. The hospital staff, surgeon, urologist, and CT scan folks were excellent and I have great respect for them and their profession.

As for so-called primary care, this is not the health care I grew up with and I don’t really know where to point my finger. The primary care PAC and her doctor focused on kidney issues due to hematuria and assumed the abdominal pain was associated. Blood and urine were taken for additional testing but the blood results took days to complete. Blood tests confirmed I had an infection of some sort. There was no X-ray, CT, ultrasound, MRI, or any imaging in the office. Getting imaging done takes a referral and an appointment several days away. A CT scan would have removed the possibility of a kidney infection or stone. I can only assume that if there was imaging equipment in the office I would have been referred to a surgeon two weeks earlier than I was, maybe even had my appendix removed that same day. Since it takes three to five days to schedule a CT scan it would seem reasonable to begin taking drugs for the most likely problem until the scan could be completed. Even then, I would most likely need a specialist referral and that can take even longer to schedule than a scan. Why can’t I go to the doctor and get some real tests done so I can get a diagnosis? Do I blame the system or just assume I chose bad primary care? This isn’t the first clinic I have found in the area. I have been to a few and shopped around. They are all in professional buildings and are staffed by approximately ten doctors and nurses. They have a microscope and a stack of magazines. Any real tests require a referral. I personally think primary care has become nothing more than a sales outlet for pharmaceuticals.

While at the hospital I told the nurse about my referral saga and asked if she knew of a primary care clinic that had at least an X-ray machine. She advised that she was not allowed to give recommendations. Fair enough, but she also said the care I received seemed standard. Usually primary care, the place I go with symptoms, is a professional building with very limited equipment. What are these places? All they can do is prescribe drugs and when I’m sick I may need more than drugs. The hospital is where the real care is but unfortunately I don’t qualify for that clinic since I actually have insurance and I’m not a senior citizen. In the end I paid more in co-pays than an emergency room would have cost. My profession as an airline pilot is also incompatible with referrals and waiting since I am essentially grounded until I know what’s wrong. I can’t just go to work while I wait for test results for documented symptoms. I am required to have a medical exam every six months and it is clear that going to work sick is illegal, stupid, and a willful violation of the law. Despite the cost I am considering skipping the bullshit and going to a real hospital with real equipment next time I have symptoms.

This leads to billing. I have great insurance. It’s a 90/10 plan with no deductible and a reasonable out-of-pocket maximum. I chose this plan over 100% coverage because even with my surgery the total cost in premiums and coinsurance is about equal to the cost of 100% coverage. These are the benefits of working for a good company and being part of a strong union like ALPA. I lost no pay since I had time in my sick bank and FMLA will keep me in good standing with my employer. This is to say, I am not forgetting to count my blessings.

I do, however, have some issues with the billing which make me worry for the day when I have no insurance. A typical test for blood or urine might be billed at six times what the insurance company actually pays. A $380 lab test gets covered at $60 by BCBS. When I asked how much my CT scan would cost I was told $2000. They billed BCBS for $850 and BCBS paid around $500. My bills all share this trait with lab work having by far the greatest discrepancy between what is billed vs. paid. Before the surgery I tried to find out what it would cost but no one could tell me. I signed that I would pay the bill if the insurance company denied my claim without a clue what it would cost. I know it depends on the resources and time used. If I had to stay additional nights in the hospital or have more surgery and blood transfusions it would cost more. Still, why can’t I get an itemized estimate ahead of time? An accurate estimate would be nice. Don’t tell me it’s going to cost $30,000 and then bill the insurance for $6500 while getting paid $4000. This is exactly what would have happened so I didn’t really mind not having an itemized bill.

I have it better than most people in America. Many folks pay larger premiums and have per-person deductibles which for a family can lead to terrible cost. Others have no insurance. Do they pay the full 600% markup on lab work? Primary care is a WTF. Billing is a WTF. At least I am alive. Thanks also to my wife for helping me with the innumerable pains and annoyances that happen during illness.