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Before you get sick, have a plan set on where you will seek care

The other day, we published the story of a Tampa Bay area man who had such a bad toothache, he went to the emergency room. A doctor examined him, prescribed medication, and now he is fine — except for a $1,367.30 bill.

Some readers were outraged at the hospital for charging so much. Others criticized the patient for taking an infected cavity to a busy trauma center.

Several shared their own hospital billing stories, some of which made the toothache treatment look like a bargain.

My colleague Stephen Nohlgren explained in the story how the insurance system has warped pricing beyond all comprehension. And it has got nothing to do with health care reform — this mess has existed for decades.

Focusing on where consumers might have at least some control, I got to thinking about what alternatives the dental patient had.

When do you really need to go to the emergency room? How do you get the most out of the visit?

And how can you avoid the place?

I put these questions to Dr. Ajoy Kumar, assistant director of the family medicine residency program at Bayfront Medical Center in St. Petersburg, the scene of the dental treatment.

He has enormous sympathy for people who think they can't afford regular health care, and then turn in desperation to the hospital. Their numbers are growing.

But he's also big on patient responsibility. Even with limited means, smart patients do have some control of their destiny — if they start planning before a crisis strikes. (These tips are for general guidance only. Always consult your own doctor.)

AVOIDING THE ER

• If you don't have a primary care physician, get one. "That's what's really going to make the difference,'' Kumar said. Family doctors can handle the vast majority of conditions, and do it before they get out of hand. No, they're not available 24/7, but ask at your next regular visit for advice on emergency care. The doctor might recommend an urgent care center that offers services you thought were only available at a costlier ER.

Quit smoking. "It makes everything worse,'' he said.

If you don't have a primary care doctor: Contact your insurer for providers in your network. If you don't have insurance call your local community health center, health department or free clinic and ask about options and eligibility requirements. Some physicians offer reduced rates to self-pay patients. Emergency rooms will not turn you away for lack of funds, however you will still receive a bill for that level of care.

• When in doubt, seek help. Don't delay treatment. Run-of-the-mill issues can swiftly become life-threatening, and the physical and emotional costs of waiting can be far worse than the financial cost.

AT THE ER

Be clear about your condition, but be patient. Especially at a busy trauma center, you might have to wait if others are worse off than you.

Check your pride at the door. "ER doctors have heard everything,'' Kumar told me. So if you're bleeding from some place embarrassing, don't just say your stomach hurts. "Be forthright. We can't read minds.''

Bring all your medications, or a list of them. Be honest about doses. You wouldn't be the first to skip blood pressure meds or take too many pain pills.

Bring somebody with you, or have them meet you if you go by ambulance. This is no time to go it alone.

• Bring your living will. Keep your doctor's business card in your wallet, or program him or her into your cell phone. Enter and store an ICE (In Case of Emergency) phone number on your phone.

• Don't expect to haggle. I asked Kumar why you can't just get a prescription rather than a pricey workup when you know all you need is an antibiotic.

"You may think you can heal yourself . . . but you may know just enough to significantly harm yourself,'' he told me as patiently as he could.

"There's a reason people spend years in medical school and more than 14,000 hours in training. When you go to a physician, you are paying for that expertise.''

WHAT NEEDS IMMEDIATE CARE?

Here are some situations in which Dr. Ajoy Kumar says to seek emergency treatment right away; ask your own doctor if your own situation warrants a more personalized list:

Stroke or heart attack symptoms mean you must call 911 immediately. Emergency workers can assess you on the way to the hospital, and get you there faster than your spouse can. Do not drive yourself — you want to crash on the highway?

High fever — around 102 or higher — that you can't get under control with medication.

Abdominal pain — so bad you can't eat, or it's accompanied by severe constipation.

A blow to the head that causes you to lose consciousness, or is followed by severe headache, nausea, vomiting.

Change in mental status — particularly in an older person.

Urgent care centers aren't the place for primary care, but they have long hours, lower prices than the ER and can handle many issues, such as ear infections, flu, severe cuts, even broken bones in some cases. Consider calling or visiting the center your doctor recommends to find out what they offer now, before you need it.

Before you get sick, have a plan set on where you will seek care

11/18/11 [Last modified: Friday, November 18, 2011 3:30am]

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