Nothing to say

Have you ever had to pay a hospital or doctor’s bill? If so, you may have been dumbfounded by how bloody much it cost. This is understandable.

Have you ever heard a worker in the healthcare field bitch about HMOs? If so, you may have been dumbfounded by how bloody cheap they are. This is also understandable.

Now, have you ever really thought about both sides of it?

Let me not get into any arguments or anything. As my friends know, I work for an HMO and I love my job. Besides that, I love the company I work for, so I clearly have no will to bit the hand that feeds me. Actually, this has nothing to do with my job. This has to do with my own personal healthcare. Me, I work for a medicare company. I’m neither disabled nor at or over the age of 65. I am insured by a commercial HMO. And I recently had surgery to remove the polyps from my nose.

Today, I had an impulse to go out to my HMO’s site to see how much they were billed for my surgery. They have this awesome function where you can see your own billing history, including the amount that your providers charged, the amount the HMO paid (at the contracted rate) and the amount of your copay. Well, MY copay in this case. For the year, it’s been 520.

My surgery was 4/6/07, with and overnight stay, and a follow-up visit on the 9th to get all the cotton packing ripped out of my nose (ow!). The HMO won’t give me a breakdown showing the billing codes or anything, but they do give me a total for each billing party. On the 6th, I paid my copay of 250 and went into surgery prep. By the time I came out, 5 different parties had performed billable procedures on me.

Bill Party    Bill Amt   Pay Amt  % Pd
Hospital      24,809.20  2,808.20  11.3
My Surgeon    21,100.00  2,508.44  11.9
Anesthesia     1,620.00  1,205.60  74.4
Pathology        775.00    199.29  25.7
Someone else      85.00     62.63  73.7
Total         48,389.20  6,784.16  14.0

Look that over for a while; absorb it.

The hospital billed nearly 25 large. My HMO paid 11.3% of that charge. Only 14% of the total bill was paid. I’m thinking about a friend who is pretty much eternally in debt due to hospital bills. I’m guessing the hospital charges people about the same amount that it charges HMOs, but the individual people are such that they lack the power to respond as an HMO would.

I mean, imagine getting a bill from the local hospital for 48,389.20, staring at it for a few moments, checking the medicare allowables for the codes you’re being billed for, and then writing out a check for 6784.16 (14% of the bill) attached to a letter saying “After reviewing your bill, I have decided that this is sufficient. I have enclosed payment in full. Thanks for doing such a great job on the surgery.”

Friends, that’s just for my surgery. My total bill for this year so far is 57,277.35 but my HMO has paid only 10,633.16, about 18.6% of the bill. Sure, not having health insurance sucks, but paying less than 20% of your bills is better than the outrageous rates that some care providers are charging. I know there are exceptional cases, but the trend is that providers receive less money than they bill, and they manage to stay in business for a great many years doing business that way, so it’s not like 18.6% is too little.

It’s just that the individual person needs a little more muscle behind them before they can contest charges this successfully.

Yesterday, for the first time in years, I experienced the following new smells:

• Orchid (the first flower I’ve smelled!)
• Rosemary
• Cigarette Smoke
• Bird seed
• Donuts and more generally the ambient smell of Dunkin Donuts

Bummer on that third one.

I have been going CRAZY since last Thursday. For the last two Thursdays, I’ve been going to see my ENT for post-operation visits. He rips a bunch of nasty crud out of my nose, talks to me about it, and then sends me on my way feeling a LOT better and breathing a lot easier. Literally.

The first week, it was like, crusty scabs, basically. Gross, but better to get them out than have them stay in there. He told me about a couple of little sponges that he left in my nose just in case my nose tried to close up with scar tissue. Their purpose was to prevent that, and then dissolve. He was letting me know, because when they start to dissolve and come out, he didn’t want me to freak out.

Last week, he extracted the last bit of sponge as well as a lot of … thick, wet snot. It was less bloody than the week before, and didn’t feel quite as good to be rid of as the previous week, but still very, very good. The incredibly remarkable thing is that on my way out, through the waiting room, I smelled it. I smelled the room.

You know when you walk into an unfamiliar home, and you notice its distinctive smell? I haven’t noticed that in years. It’s way too subtle for me to have noticed since the operation - during which time I could only catch really strong scents, and found a lot more to appreciate in my food. After that visit, though, I was smelling entirely new things. Still entranced by this significant change, I walked down the stairs. When I reached the bottom and opened the door, I was overwhelmed by cinnamon, coffee, and freshly baked bread. It had been years. I couldn’t believe how incredible it was. Au Bon Pain has never been such a welcome sight. It has never been a scent, welcome or otherwise, for me. I can’t even describe the feeling. All I can tell you to convey the serious amazement and pleasure I was experiencing is this: I started getting light-headed from all the excessive breathing I was doing to keep the scents passing through my nose.

Since then, I have smelled Kia’s hair and breath (no halitosis! Thank goodness!), cooking white rice (AMAZING!!), cardamom (I raided the spices!), chocolate, soup, grilled chicken, cut grass, a horrendous assault of colognes and perfumes (vile dolphin mall!!), and so many other things too amazing to understand.

My ENT/Surgeon is amazing. The gift of scent is amazing. White Rice is amazing. Kia is amazing. Life is amazing.

I just wanted to share.

This is a big deal. It’s the first time I’ve sneezed since the sinus surgery. All the packing is out, and I’m not allowed to sniffle or blow my nose. There are clots all over the place in my sinuses, and if I upset one of them, I could hemmorhage and bleed all over myself. That would be bad. Holding on a sneeze or sneezing through my nose would be too much force on the blood vessels and clots up there, and could be seriously bad, so I have orders to sneeze in my mouth open. As a result, I’ve been afraid of sneezing at all.

I just sneezed, though, and everything is fine. My nose is ok.

In fact, today is my first day with the gauze removed. I’ve been taping gauze under my nose like 23hrs a day since I got home, often with a mask over it to hide the pinkness from unsuspecting onlookers. Nobody wants to see my blood while they’re eating lunch, you know. So today I’m gauze-free and loving it. I gave Kia a kiss when I left. I drove all the way to work. I’ve been chatting with coworkers. I’ve been just sitting dutifully at my desk, typing away, and there are no problems. My nose was a little runny over lunch, so I had to wipe a few times, but I went to lunch with a friend who is also a nurse, so it was no big deal.

We went to Panera, in fact. I had a big sandwich and a bowl of soup. Not a half sandwich pick2, mind you. No, I ate a lot of damn food. And it was awesome. My friend ordered my favorite sandwich there, but they gave her the wrong one. She ended up with a Panini, and can’t have cheese, so she couldn’t eat it. I had the cashier fix it, and they let us keep the wrong sandwich, so I’ve got that in a bag for later. SO MUCH FOOD! I’m thrilled. It’s the only way I’m going to make it through the day. I had two donuts, a cup of organic blueberry yogurt, coffee, and I think something else for breakfast. I’ve been consistently eating like 30-50% more food each meal since the surgery-nausea dissipated. Piggy :8)

Life is great.

I was discharged from the hospital today around 9am. The surgery went well, and my otolaryngologist/surgeon removed all my polyps and found one sinus packed with fluid. He was completely successful at removing everything, and spoke with Kia afterwards. She was so good to me through the whole thing.

So I’m home and happy and healthy now. Life is good.

Next up is the fold. I’m going to go through a sort of play-by-play of the surgery for anyone who is interested, but it will include PICTURES. If you don’t like the sight of blood, don’t look. Seriously. Some of them are kind of gross.

Ok, there’s no way to do just partial posts here, and then have a click for a full thing. And I’m kinda cloudy-headed. So in the interest of not totally grossing everyone out, you get no pics.

Cheers.

So I went to the Otolaryngologyst, Dr Dougherty, and he says that I still need the surgery, because the antibiotics alone won’t do it. I was in a fair amount of doubt, because my PCP had told me, essentially, that if the polyps go away, they’re as gone as if they were never there. So he called Friday morning, the day of my appointment with the ENT, and told me that the blood test results were in and my white cell count was “elevated” so he wants me back on Levaquin after the surgery. Ok.

After meeting with the PCP, I was rapidly leaning towards “no”, but I spoke with Kia that evening, and she told me what her dad (who has had the surgery) said. “Do it.”

So I’m doing it. The appointment is this Friday, the 6th.

In other news, Kia changed my wallpaper for April Fools. I think I got off pretty easy (OH DOUBLE ENTENDRE!)

Damn, that girl’s funny. The best part is that she had to make me minimize all my windows to see it, because I didn’t bother to check the desktop all day.

It’s just after 10. I have an appointment with Dr. Dougherty at 11. I’m going to talk to him about the virtues of Antibiotics vs. Surgery.

When I took the 10 doses of Levaquin, I got one sample and a prescription for 9 more. The 9 pills cost me a $40 copay, with a total bill of over $90. I can’t remember where I saw it, but I’m under the impression that the surgery will cost over $6,000, with a $500 copay for me. Baptist hospital may or may not be the best in S FL, but it’s inarguably the most expensive. A month-long round of pills will be a lot of money, but not nearly $6,000, and it will still max out at a $40 copay for me.
Surgery will also cost me at least 2 days off work, and then another half-week or so of Very Tired days at work. I will also have to get my packing changed on Monday (specialist visit, copay: $25)
Finally, there are the risks. Antibiotics wreak havoc on my stomach, and if I don’t follow the prescription (or if the prescription isn’t right), I run the risk of strengthening my bacteria, making them even harder to KILL OFF. Still, that doesn’t compare to the surgery risks, which range from infection to eye injury to spinal fluid leakage. Of course, they’re rare, but so are the more serious risks of antibiotics.

So really, it’s no contest. Given a choice, if these two options were equally effective, I will cancel my surgery IMMEDIATELY, and drive straight to my PCP hoping to get a prescription. No contest.

I’ll be back in a couple hours to let you know how it turns out.

I went to see my primary care physician today for a pre-op checkup. That is to say they’re checking me out to make sure I’m healthy enough for my surgery on Monday, April 6.

For the life of me, I couldn’t tell you what the surgery is called, but the surgeon (also my otolaryngologist, or ear/nose/throat Dr) is going to stick a tiny thing up into my sinuses and hack out all of my polyps.

The thing is, when I had the flu, I went to my PCP and he gave me a ten day dose of 500mg Levaquin. Since then, my nose has cleared up considerably. Saturday, March 17th is the first day in several years that I fell asleep with my mouth closed. Yesterday, Sunday the 25th, I tasted a Negro Modelo in a whole new way. Before my nose went totally south and I could no longer smell properly, I never drank beer. Now, I will occasionally have one, especially a darker one. Yesterday, however, this familiar bottle contained something very new to me. In fact, that whole meal tasted beyond incredible.

So I went in for the checkup today, and my PCP was blown away by the difference. He said “I can hardly believe it.” So now what?

Well, my polyps have reduced considerably. In fact, you can even see the difference in my face. My nose used to look swollen by comparison. Now, it’s thinner. the pressure is mostly gone, and I’m just feeling SO much better. So I asked my Dr about it, and he of course deferred verdict to my surgeon.

What I wanted to know for sure, though, was how polyps worked. So I asked. My understanding of fat cells is that, once created, they are always there. They can shrink in size, but never disappear. He said that is true, and that it makes it easier to regain weight. My question was whether polyps worked at all like that. Does my having polyps, or having had polyps, predispose me to having them again? He confirmed my understanding that, no, they’re more like blisters. Fluid between two layers of cells does not create new cells, and once a blister has subsided, there is no predisposition to reoccurrence.

So what I get out of this is that either a) I don’t need surgery or b) the surgery is going to be a lot simpler than was previously expected.

I also spoke with my PCP about my sinus infection. He said that having discolored snot (green/yellowish) does not mean that I still have an infection. It’s a common misconception. However, my ten day dose is smaller than what is generally prescribed for such a sinus infection. He said that typically, they’ll do a 14- or even 30-day dosage. Wow. Ten days was enough to rip up my gut something fierce. I can’t imagine a full month of antibiotics, but I would be willing to do it if it means retaining the ability to smell and to breathe through my nose.

You can’t even imagine how great it is after all this time.

Last Monday, I came down with a really nasty cough. It was affecting me at work, but I got some food before class, and felt better. I didn’t get through even half of class before I felt awful again, and had called Kia for a ride home (we were down to one car at the time) a little after eight. By 8:40, I was on my way home, and feeling absolutely dreadful.

When I woke the next morning, I immediately knew I couldn’t go to work. Kia confirmed my fever, and I ended up sleeping until after 11:30. In the late afternoon, I called AAA and got the Cabrio towed to Firestone. The poor car burst out in a terriffic oil leak a couple weeks before, and I had not yet had it repaired. Kia took me home after I got the Cabrio dropped off. I don’t remember eating that night, but may have.

Wednesday, I was no less miserable than the day before, so I called to setup an appt at the Dr. They got me in quicker than I could get there, so I cleaned up quick as I could and we left. After the visit, I had a free Levaquin 500MG with a prescription for 9 more, and was utterly exhausted again. We ran errands, including taking care of the prescription, and when we got home a couple hours later, I went to bed.

Thursday, I was determined to go to work. I had already taken enough time off. I felt slightly better, but was exhausted, so I stayed home for half a day. That afternoon, I felt better, though my stomach was cramping and flipping knots from the antibiotics. At work, I took my second dose and proceeded to partly lose consciousness. I thought my fever had come back, but I understood better after I checked the paperwork for the Levaquin. Stomach issues, sensitivity to bright lights, headache, blurred vision, etc… I had all of the above. 5:30 could not arrive fast enough.

Friday, I woke up, felt … half decent, and came to work. I had changed the antibiotic dose to an evening schedule, so that wasn’t effecting me. To help my stomach flora, I had picked up yogurt at the grocery store. To help my own energy levels, I also got oatmeal and milk. I made it until 3:00 and had to call Kia for a rescue. I was out by 3:45.

Saturday, I ran a couple errands (breakfast and CSA veggies!) while Kia was at Yoga. I was asleep in the car when she got out. This is the reason I wanted to post to begin with. The Levaquin had been steadily improving my quality of life by reducing the polyps in my nose. I was slowly regaining my ability to breathe through my nose. Saturday morning, my friends, was a magical step for me. There in the car under the warm sun, for the first time in many years, I fell asleep with my mouth closed.

I slept a lot both Saturday and Sunday. The weekend was actually quite boring for that reason.

Today, Monday, I have just made it through a full day of work. I’m tired, my stomach is still fairly nutty, and I’m definitely not thinking with a totally clear mind, but I made it. Now I have to go to class, and I’m pretty much dreading it. I had a massive lunch, and plan to nap briefly before class. Hopefully that will get me through it.