When we were in Houston for my brother's wedding, Charlotte spiked a high-ish fever: 102.1. She's never been a sick kid and at almost ten-months-old had yet to make even ONE sick-child visit to our pediatrician.
(This is completely INSANE as I think Claire had at least 5 or 8 sick-child visits at this point in her life. I would like to say it's because Charlotte was not in a group child care setting and Claire WAS, but I think it mostly has to do with winter-baby/summer-baby and an older sibling that sucks her thumb, which is the grossest thing in the whole world.)(She also steals the baby's binkys, which is a whole other post. GOD, she is such a germ-sharing factory.)
Ahem. Anyway.
A fever (with congestion that had been going for a few weeks) made me think it was an ear infection. But, we were out of town so I dosed her with Motrin, saw the fever drop, put her to bed, and hoped for the best. She woke up at 11pm, breathing quickly, and so, so, so hot. She was crying and almost inconsolable. I took her temperature several times with a newish temporal thermometer we'd bought. 102....103....104? ONE-OH-FOUR? WHAT?
That was a really high number, but it seemed weird that I'd get such dramatically different readings in quick succession. I wondered if I was using this fancy new thermometer wrong? I figured if I was using it wrong, it would give me a LOW reading and not a high one. It can't measure that high unless something is that hot. (Right? This is how my brain was working.)
I called the overnight nurse back in Ft Worth and she explained that if Charlotte had been recently laying down (as she had been, ASLEEP and all), it would make the surface temperature of her head a lot higher than her actual temperature. Since it had been several minutes and she was upright, she wanted me to try again, with three subsequent reads.
101.2
101.1
101.2
That's better. (Well, as better as 101 is.) She calmed down, nursed, we gave her some more Motrin and put her back to sleep.
(SIDEBAR! Our pediatrician is a part of the Cook Children's Medical Center. Cook Children's is the Ft Worth medical center of choice and I have been SO SO SO impressed with them for the past 3 years. They have an app that I have used several times [all while out of town, go figure]. It's got really simple information in it that you could Google, but I find that it's comforting/reassuring to find out what Cook's has to say about fever/puke/whatever in the middle of the night [when I'm right on the edge of panicky thoughts and don't need any more crazy added to the mix] rather than Dr Google. It's blanket information not specific to Cook's, so if you wanted to get the app, just go here.)
The next day Charlotte was irritable and cranky. I still thought she probably had an ear infection. She was now pulling on her ears and shaking her head. I called our pediatrician and asked if they thought I should take her to an urgent care clinic or if treating an ear infection with antibiotics isn't something they'd want to do anyway. (Some practices skip antibiotics for ear infections, depending on a variety of factors.) My ped's nurse told me that they DO treat an ear infection with antibiotics and I should try to get her seen. She recommended a pediatric urgent care, but a regular urgent care would do. Just try and get her treated.
Okay. We can do that. After all, we are in the fourth-largest city in the United States.
We had several hours until the rehearsal dinner and I felt pretty confident that we'd get her to a pediatric urgent care clinic, seen, diagnosed with an ear infection, and fetch a liquid suspension of antibiotics well before it was time to get dressed for the evening. I Googled for a pediatric urgent care and came up with nothing close. (Houston is about 50-miles across and in traffic on Friday afternoon? Going far could take HOURS. It took us 45 minutes to drive four miles across town. I needed something close.)
Okay, maybe just a plain old urgent care clinic? One of the first results was the CVS Minute Clinic. Huh. that sounded pretty....decent. Considering she wasn't in immediate distress and I really WAS about 90% sure we just needed a peek with an otoscope, this sounded like a very efficient and cost effective way to get her treated. But, I wasn't sure they'd see a baby. I looked on their website and called the 866 number (it hung up on me) and even called the specific location, but nobody was able to tell me if they would see a nine-month-old.
SIGH.
I looked on my map some more. I found a pediatric facility, but it looked kind of far away. There were more in the suburbs, but in the center of the city there was nothing for kids. (People in the city...don't have children that get sick on the weekends? What? No.) We went inside and nope, they don't see kids under 18-months-old at CVS Minute Clinic. They directed me to another urgent care clinic down the street that saw babies.
Except, they didn't treat babies either (even though I asked her if she knew a place that WOULD SEE A BABY OMG PEOPLE ARE IDIOTS SOMETIMES). They sent me to anther place (and I was SURE to specify URGENT CARE that treats babies and not EMERGENCY ROOM, because $$$$$), but it was an ER.
The second I saw the sign out front, I knew it would cost Big Bucks to have someone hold an otoscope to her ear. I am a reasonable person and I want my baby to feel better, but this is not a $600 problem. But we were there, so we walked in. The first thing I said was, "How much is a visit to check out her ears, cash, no insurance?"
You guys? She gave me A Look. A "OH THAT IS SAD, NO INSURANCE" look!
And that pissed me off!
Because, what the shit? Having insurance or not isn't a reflection about a person's character or financial circumstances (NOT THAT IT MATTERS OR IS HER BUSINESS ANYWAY). It's just me asking, in a reasonable tone, "What is the price?"
You know, like a normal person asks before she spends money? It's not a sad thing! Not an embarassing thing! It's just how commerce works! We agree on a price and then I decide if I want to buy what you are offering. Nobody gives me A Look at Starbucks when I ask how much an extra shot is. There is not unlimited money, Judgey Receptionist Lady. People need to know what things cost.
We are insured, but we are on a very high deductible HSA, and we are responsible for 100% of our sick visits until we meet the deductible, which we hope not to meet because that would mean someone got really, really sick. Whatever this was going to cost, we were going to be paying 100%. Asking for the no-insurance price was the quickest way to get to the answer.
And you know what? I am fine paying for my family's sick visits, including emergency visits, if necessary. Really. I am! I understand the limitations and responsibilities of my plan and we have budgeted accordingly. I know that a broken arm is going to set up back a few hundred bucks. (Maybe a grand. Let's not go there today.) But, I want to know what I am going to pay before I incur the charge (again, AS A NORMAL PERSON DOES), especially if it's an elective visit. This was another problem we were having: not only did we have a sick baby while out of town, we were now seeking non-emergency care in an emergency setting because none of the urgent care clinics would see a child under 18-months-old. The ship had long since sailed to try and get a regular appointment at a local pediatrician's office that afternoon. We were pretty stuck.
So, I have asked her what it's going to cost and she gives me the pièce de résistance of my wedding weekend medical quest: She told me she can't tell me what it costs because they are an ER and they have to see everyone. Let me repeat: She knew what it would cost and she refused to tell me. I was not asking IF she would see my child (I am aware that an ER has to see everyone), I was asking WHAT IS THE FEE.
I think she was trying to say that in a true emergency, cost doesn't matter. In a life-or-death situation, I tend to agree. Am I bleeding out? Please save me, no matter the cost. Did I skin my knee and I need a band-aid? No, I do not want to pay $500 for that.
The huge, enormous gap in this process is it's MY decision to make, not hers or her company's. MINE. (If this turns out to be a legal issue, that an ER is prohibited by law from telling someone what a visit might cost, then I'll be REALLY horrified.)
There's a HUGE connection between what it costs to be treated and whether a person CHOOSES to be treated. The idea that these two things aren't related or heavily intertwined is ridiculous. People make these decisions every day! It's RESPONSIBLE and NORMAL to want to know and use this information as part of the decision-making process when seeking medical care.
Live with the backache or get the expensive surgery?
Wait for strep throat to clear up in 3-7 days or go see a doctor and pay for that visit plus an antibiotics prescription?
And, at the extreme, take the heart medication or eat dinner next weeK?
People in America are making these decisions, and far more heart-wrenching ones I can't even imagine, EVERY DAY. Money is a BIG PART of seeking treatment for a health issue.
Cost and treatment are not mutually exclusive.
I wanted to yell at her. Scream at her. Shake my hands at her. Rain a storm of simple logic and three-syllable words on her.
I started to really understand the phrase, "access to care." My child needed care and I couldn't access it. The one place that I could access care, was for an unknown, hidden, deliberately withheld cost. And you know what? That is fucked up.There we were in the fourth-largest city in the United States of America, insured, willing to spend (not an exorbitant sum of) money to have our daughter's ear checked out, running every set of keywords I could think of via iPhone on the tollway, and still having a problem getting access to care. All the blessings in the world and nobody will tell me what it costs to hold an otoscope to her ear and see if this poor child's middle ear is infected.
"Frustrated" does not come close to conveying my feelings that afternoon. We were out of time and out of places to go.
We took her to the rehearsal dinner and she was fine. Happy, chatty, smiley. She wasn't feeling TOO terrible. This entire thing was a "nice to have." We tried to get her seen, we couldn't, we moved on with our plans. She seemed to do just fine, but ran a lowish fever and shook her head/pulled her ears all weekend. Probably uncomfortable, but still in a good mood.
We went to our normal pediatrician on Monday, once we got home, and she took one look in her left ear and saw a "raging ear infection." $5 for some amoxicillin, $144 for the visit and she was feeling much better the next day. The whole thing took an hour.
***
We had two problems: she was under 18-months-old and we were out of town. Left to turn to an ER, a policy that appears to have been designed to make sure everyone had access to care ushered us straight out the door. Yes, we could have accessed care, but we chose not to because the providers withheld information that was crucial in our decision-making process. Of course, if it had been a true emergency we would have been able to get her seen at a hundred places. But, it wasn't. It was an everyday problem that we were not at home for. She fell through the cracks, got tangled in red tape, pick whatever metaphor suits you, because we were all over it. Too young to be treated here, unknown cost over there. Game over.
I can handle a baby with an ear infection and make her comfortable. What really got me was that I tried to get my baby treated and I failed.
I felt like I had failed her.
In the future, I will seek out the nearest pediatric urgent care clinic when we travel. I have already identified the nearest, takes-our-insurance facility in the cities that the grandparents reside.(Because even if I'm paying, you bet your ass I also want the negotiated rate.)
I also went ahead and forked over $26 for my very own otoscope and I'm going to ask our pediatrician what to look for and how to use it (along with Dr Google, of course). I have a feeling this request is going to make her wince, but this is what lack of universal access to and the ridiculous, oddly secretive cost of medical care in this country has come to.
It's just all so very modern, isn't it?