What if you developed a kidney stone? First, there is a trip to your primary care doctor because you experienced testicular pain—yes, it’s not always in the back! Your doctor has you give a urine sample, and seeing microscopic blood there, suspects a kidney stone. His instructions? Drink plenty of fluids to help it pass. He orders a urine culture to check for infection, takes blood work to make sure there isn’t another problem, tells you to make an appointment with a urologist within a week, and sends you home. This is appropriate care. Cost: $129.
You find out your blood test is mostly normal, except for a couple of elevated liver enzymes. You partied for New Year’s Eve a week ago, so it’s probably not a big deal.
About a week later, the pain starts up again, only this time it is mostly lower left abdominal pain, with testicular pain. Over the next hour it intensifies and you can’t sit or stay still. Off you go to the emergency room because you can’t take the pain anymore, and you have nothing to help it.
Now imagine you have health insurance through your state’s health exchange, courtesy of the Affordable Care Act (ACA). No doubt you are concerned about what is going to happen if you need your health insurance this year! And the short answer is, no one knows what is going to happen. Things are changing every day now.
At the ER, you are taken back in a reasonable amount of time, and talk to a couple of nurses who want to help you. After a little while, the doctor has ordered an ultrasound to make sure you don’t have testicular torsion, a true emergency for young men. It looks ok, so then the doctor comes in, gets a history, they start and IV, and finally you receive some pain medication. Relief at last. They take some more blood to check for infection (part of a CBC tests for an increase in white blood cells, which signal infection) and a blood chemistry panel—these are standard blood tests. Lastly, you are sent for a CT scan.
It turns out there are 2, not 1, kidney stones! One has passed through the ureter (the tube that passes urine from the kidney to the bladder) and is stuck at the junction of the ureter and the entry to the bladder. And there is another small stone left in the kidney. That means this will most likely all happen again! For now, the worst is over, thank goodness! The blood tests reveal that everything is normal except those pesky liver enzyme levels are higher than they were before.
(https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones and http://umm.edu/health/medical/ency/articles/kidney-stones show pictures and information about kidney stones)
The hospital readies you for discharge with 3 prescriptions: maximum strength ibuprofen, a narcotic in case that second stone starts to pass, and Flomax to help the ureter relax and pass the stone. They also tell you to go to a urologist within 24-48 hours. And, maybe you should also go to a gastroenterologist to check out those elevated liver enzymes. Cost for the ER visit with all tests: $2798.88. And that does not include the ER doctor’s or the radiologist’s fee, which will come to somewhere between $500-1000 altogether. That’s up to nearly $4000 already.
You get my drift. Health care is expensive, and in this case, everything went pretty well. Everyone with an ACA health insurance plan will experience uncertainty about their health insurance coverage until the dust settles.
Medically, still to come, you have two follow up visits to the urologist, a follow up x-ray, any costs to follow up the second kidney stone (the urologist says, “Call me, don’t go back to the ER and have all those tests repeated.”), and more tests to come to find out why you have kidney stones. And at least one follow up blood test to check those liver enzymes-good prevention! For the most part, this is good, standard care, if all continues without a hitch. The costs add up fast.
Today, the Washington Post quoted a health care consultant as saying President Trump’s inauguration day executive order threw a “bomb” into the ACA. This health care consultant is not be a fan of the ACA and you can read his take on it here: http://www.healthpol.com. But he is right, no one knows what this executive order means.
Groups like Families USA, http://familiesusa.org, who support the ACA are studying the new executive order. Another meeting is going on right now at the Capital Area Health Network with Senator Mark Warner of VA, so there should be more advice on how to manage with your ACA plan soon. And let your voice be heard, call your legislators to let them know what you’re thinking. Millions of Americans already have and your voice is needed too.
If you’re covered, I suggest you stay covered. If you’re still signing up for a health insurance plan for 2017 through an ACA health exchange (by January 31, 2107), I still think you are better off covered than not.
What if you got a kidney stone? Or worse?