By Eric Funk
As a patient with a long history of atypical migraines, I have firsthand experience with the importance of controlling costs of care. I have seen attempts to reduce expenses throughout my journey within the healthcare system. At a primary care office, I was congratulated for scheduling an appointment with my primary care provider rather than using the Emergency Department. The tone of the physician spoke to the cost that the ED visit would have incurred. The initial primary care visit and subsequent prophylactic medication I was prescribed have certainly saved me from many ED visits during the last years. The prophylactic medications I take only cost $10/month, and my awareness of the costs involved in preventing a migraine help me make an informed decision. As I have learned, preventing a migraine is much more affordable than treating one. I instructed my spouse to not take me to the ED until it was truly our only option, in order to avoid the unknown costs.
Several months ago I woke up with severe pain and a strange array of neurological symptoms, and knew that I was beginning to have another migraine. With the help of my spouse, I found the medication I had been prescribed to attempt to abort the migraine. After providing a small amount of initial relief, I was again awake in a few hours with worsening symptoms. My vision was clouded by the aura that many migraine patients experience, and I was stumbling around our apartment. My ability to form coherent sentences was worse than any previous migraine, and my spouse decided it was time to visit the ED. In this situation, the costs of an ED visit were only a small factor in the decision to seek care. We knew it would be expensive, but I would have been willing to pay an exorbitant sum of money to stop the symptoms.
In the ED, I was seen and assessed promptly. My wife heard the doctors discussing ordering a CT of my head. She quickly expressed her hesitation about getting a CT scan, partly because of the cost and partly because of the radiation exposure. It was important for the physicians to hear from someone advocating for me, while still being able to use their professional expertise to assess the necessity of a CT. In the end they decided not to do any imaging, and I was provided with one 500cc bolus of normal saline, Compazine and Benadryl. After several hours, I was well enough to go home.
In the following weeks, my wife and I anxiously waited for the bill. We knew the expense would be high, but were not sure if the visit would cost us hundreds, thousands, or tens of thousands of dollars. Fortunately, I am still on my parent’s insurance thanks to the Affordable Care Act, so we knew that would offset a portion of the cost. The bill ended up being about $800. Hearing multiple horror stories of people who have been stuck with ridiculous bills had scared us into not accessing care as soon as we might have otherwise if we had an accurate understanding of the costs we were going to incur. An awareness of costs in medicine not only enables patient autonomy and more informed decision making in elective situations, it also will prevent many individuals from delaying necessary or emergent care.
Eric Funk, graduate of Tabor College in Hillsboro, KS and the University of Kansas School of Medicine, is currently an Emergency Medicine intern at the Mayo Clinic in Rochester, MN and is one of the four finalists in our 2015 Costs of Care Essay Contest.