8/2/2024

So after I aced a physical fitness test written up in the Washington Post,¹ I developed a slight discomfort in my right abdomen. At first I thought it might be due to the section of the test that required me to hang from a chin up bar for 60 seconds, but when it continued after a few months I figured I should do something about it.

They say that timing is the secret to life which was born out by the fact Mrs. AAR and I were planning a summer Antipodes getaway and I didn’t want to have to seek medical help on the other side of the world. Therefore I decided not to book anything until I figured out what the hell was going on.

Since I have never used my health insurance in the 2+ years I lived in Kansas City, my first step was to find a primary care provider. My insurer thoughtfully provided a list of in-network providers. I contacted one nearby and was informed that they would gladly make me an appointment . . . for three months from now.

Well as I worked my way through the balance of the list, three things became readily apparent:
 

1. While it contained the names of over 100 doctors, they were all associated with the same ten phone numbers. So in an effort to cut to the chase I just compiled a list of phone numbers and started dialing

2. It turned out that these 10 phone numbers all led to the same five providers.

3. The best I could hope for from these five providers was an appointment three months hence. So I made a couple with two different outfits, asking them both to call me if something opened up earlier.² 

After completing my telephonic odyssey, Mrs. AAR recommended I make an appointment with her doctor, to which I replied “So I’m just going to call her, make an appointment for early next week and that will be that?” And it was, though the appointment was made with the nurse practitioner.

The day before my appointment I was texted a reminder and a link that thoughtfully allowed me to fill out my paperwork online. It also allowed me to input my insurance details in a format that unfortunately does not match what is on my insurance card. I’ve noticed this before at the pharmacy and my dentist where terms like subscriber #, Member ID and Policy Number are confusingly interchanged.

I did my best to fill in all the blanks, about my insurance (Ambetter Standard Expanded Bronze), any medicine I was on (thankfully none), and prior surgeries (right big toe), but I guess it didn’t save correctly as when I arrived at my appointment 15 minutes early, I was required to fill out all the same information (and more) on numerous pieces of paper in an empty waiting room. I only mention the condition of the waiting room, as every other doctor’s waiting room I ever waited in was filled with people, usually with more than a few looking like they should be waiting in an emergency room.

Besides my abdomen I also wanted my nurse practitioner to take a look at my blood pressure. A few months before I had it taken and it was 140/90, and the prior week it was disturbingly high at 160/94. Thankfully this time is was a reasonable 126/81, which may have been affected by my prior week long abstinence from alcohol and coffee. The engineer in me had to kick myself as now I had no idea which abstinence was the culprit. As readers may remember from a previous article, I really enjoy bourbon.

My abdomen was inspected and blood tested with negative results (which in medical terms is a good thing). Next was a CT scan of my abdomen and pelvis (with and without contrast) which was scheduled for two days later. While I was a little nervous, I was impressed the thoroughness of American medical industry and its urgency to get this issue resolved.

An impression that was dashed when my insurance required two weeks to review whether a CT scan was actually warranted. They’d “partnered” with a company called Evolent to provide a third party determination of whether my CT scan was the best way to proceed medically . . . or perhaps the best way to proceed economically. After two weeks of phone calls, emails and even faxes, it was determined that an ultrasound might actually be a better alternative.

I decided instead to pay for the CT scan myself. While I didn’t like the idea of paying $863.50 out of my own pocket, I felt that my health might just be worth it. Also I had the aforementioned travel plans burning a hole in my pocket. And I didn’t want to wait another two weeks for an ultrasound to be approved (or not).

Only it wasn’t $863.50, it was actually $977.63. You see even though I had been quoted $863.50 two times, when I went to get scanned the price had now suddenly increased, something about it being “with contrast.” Well I paid it, as I figured that my health might just be worth the additional $114.13. After drinking an excessive amount of bad tasting contrast, and then being injected with contrast that makes you feel like your wetting yourself, I was scanned. With the scanning taking but minutes.

The next day I told my nurse practitioner the news (about being scanned, not about the cost or having not wet myself) and asked that I be updated “with the way forward.” Her scheduler called the next day, though cryptically leaving a voicemail that stated “the scan showed two stones in your gallbladder . . . but it is very doubtful this is the cause of your mild stomach discomfort . . . everything else looked normal . . . there’s nothing to explain your discomfort . . . so hopefully it just gets better.”

Now I of course did what any good patient in the 21st century would do, I googled “What are the symptoms of gall stones?” And while my symptoms and the symptoms didn’t match up perfectly, the fact that my abdominal discomfort seemed to get worse after eating now started to make sense. Either way, even though I’m an optimistic sort, I decided not to go with the “hope” option and made another appointment.

The day before my appointment I was texted a reminder and a link that thoughtfully allowed me to fill out my paperwork online . . .

Epilogue
Due to a variety of factors such as the gall stones not being located in the bile duct, there being no inflammation and that my abdomen was not tender, it was determined that I was most likely suffering from what was once called a spastic colon, but which has been now rebranded as Irritable Bowl Syndrome (though I’m not sure which is worse). And therefore the way forward was to make an appointment for three months hence and watch my diet, with it all hopefully just getting better.

Epilogue II

- My nurse practitioner co-payment was $50. Though I subsequently received a check for $50 from my insurance company for "Refund of Patient Overpayment For." I have no idea why, though maybe my nurse practitioner felt guilty about not adequately pressing my case for the CT scan?

- My blood work cost $610.05, though there was an adjustment of $577.88 for “ADJUSTMENT(S)” with insurance picking up another $40.44, so in the end it cost me $11.73.

- I wrote the CEO of the CT scan place and asked for a credit of $114.13 . . . and I’ll be damned, he agreed and had it credited!

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¹ A Washington Post subscription that was generously gifted to me by a thoughtful (and handsome) subscriber.
² Regarding the call back from the in-network providers for an appointment < three months from now: I’m still waiting.

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