The Cost of Getting Influenza
When good medical decisions are bad financial decisions
It all started on a Friday morning in February. I’d gone to bed the night before with a sore throat, certain that I’d just picked up a little scratchiness from a mid-week ski trip with friends. But I awoke to a new sensation: muscle aches all over my body. Surely this was the mountain’s revenge, too, I thought. I hadn’t gone skiing since last season, so why not a little residual pain?
I headed downtown to teach a class, water bottle in hand (for the scratchiness) and ibuprofen already in my system (for the aches). I figured I’d power through it and get back to the office in good time. After all, the next day — Saturday — was the biggest annual event on my calendar, a yearly conference of which I’m in charge. I was expected to lead the opening session, to bring most of the materials for set-up, and coordinate on-site with our speakers and workshop leaders. There was a lot to get done, and sickness was not on the agenda.
At noon, I showed up to the office. My colleagues instantly noticed how pale I was. I began to suspect that maybe the past was repeating itself: exactly a year ago, I had come down with a bad cold one day before the same big conference. At the time I chalked it up to stress-induced immune weakness. Perhaps this was the same thing.
Within about an hour, my condition took a serious nosedive. I remember standing at the copy machine, feeling slightly delirious, and steadying myself on the table to avoid collapsing. “You should go home,” said one colleague, meaning it less as a suggestion than a firm directive. I finished my copies, loaded up my car, and stood in the brilliant sunshine for a moment. “Warmth,” I said, eyes closed and swaying. My colleague looked at me with worried incredulity. “Are you going to make it home?” she asked.
I crawled into bed at 3:00 p.m. and didn’t re-emerge until 6:00, when my phone rang. It was a friend calling from another state. I don’t remember much of the conversation, but she later informed me that I was barely forming coherent sentences. When I finally stood up, I felt the Icy Black Hand of Death upon me. Every muscle ached, I was somehow sweaty and chilly at the same time, and it took every ounce of strength I had to crawl to the living room. My friend told me to go see a doctor. “Yes,” I whispered. “Doctor. Where is doctor. Doctor now please.”
This was my decision point: where would I seek medical attention? Last year, my regular physician switched to a “membership plan” model, whereby patients would pay a membership fee in lieu of using insurance coverage. Hers is a small-scale practice, and although I understood the economic need for her to no longer deal with filing claims, I was still disappointed to have to find another doctor. I am fortunate to have pretty good insurance coverage, so I simply couldn’t justify paying a membership fee for visits that my insurance would cover with another provider. She made the switch at the end of 2016, which meant that, in February, I was still doctor-less.
In my delirium, I remembered the flyer. I had purchased my home the year before, and soon after, I got a flyer in my mailbox about a new hospital just a few miles up the road. It was newly-built, part of the local university health system, and they even gave me an emergency medical kit for my car as part of a free promotion. I was primed to feel good about the care I might receive there. And I knew they would take my insurance.
So when I was at death’s door with what my phone-friend suggested was probably the flu, that’s where I went. I was admitted, I saw the doctor and several nurses, I got a chest X-ray, I had a pulmonary test, and took a swab to confirm that yes, I had Influenza A. “Did you get a flu vaccine this year?” the nurse asked me. I was curled into a ball on the table, huddled inside an old college hoodie. “Yes, in December,” I squeaked. “Eh, this year’s batch didn’t really match the virus that’s going around now,” she said, with a hint of ruefulness thrown in for how abject and pitiable I must have looked.
To fill my Tamiflu prescription, I ended up driving eight miles away to find a Walgreens that was still open at 11:00 p.m. on a Friday night. The next day, I survived my event largely thanks to an array of amazing volunteers who took on the tasks I couldn’t perform. And also thanks to medication, a surgical mask, gloves, and hand sanitizer. (I would never advise anyone to go to out in public while sick, but this was literally the one single event in my entire work calendar at which I had to be present. What else could I do?)
But here’s the real rub: even if you get the flu vaccine, you might come down with influenza. And even if you have a regular doctor, you might get sick at a weird time that requires finding a medical facility that’s open. And even if you have good insurance, and the medical facility accepts that insurance, you might end up paying a really, really large amount of money.
Here’s what getting the flu cost me:
Co-pay at the hospital at time of admitting: $240.00
ER visit charges, after insurance: $619.60
Physician’s fee, after insurance: $295.52
Radiology charges, after insurance: $399.00
Tamiflu and albuterol inhaler, with prescription benefit discount: $57.00
Total cost, after insurance: $1,611.12
I am extremely fortunate to have decent employer-sponsored insurance, and doubly fortunate that this bottom-line cost was not an issue for me. My plan has a $1,200 deductible, and after it’s met, the plan covers 80% of costs for in-network procedures up to a yearly out-of-pocket maximum of $3,800. After that, everything is fully covered.
My biggest error was going to this particular hospital. I was informed after the fact (i.e. on the phone with their billing department) that this facility is a “boutique hospital,” a cutesy moniker that apparently allows them to charge exorbitant fees for service. Had I been thinking clearly, I might have sought out an urgent-care facility, which would likely have had lower fees. But when your brain is addled by influenza and it’s late on a Friday night, what choice is obvious? I knew that hospital existed, so I went to it. My mistake, apparently.
The final irony is that my professional work includes public policy advocacy for low-income families. How many of them would have been nearly bankrupted by an incident like this? Would they have even gone to the doctor, fearing how costly it might be, or simply tried to “tough it out” without medication? No one should have to be fortunate (in any sense) to afford basic medical services when they get sick.
In the end, I’m thankful for the people that helped me take care of myself — friends, colleagues, and medical professionals alike. But I learned the fundamental lesson that so many people have learned when navigating the modern American health care system: don’t get sick. And if you do, don’t be surprised if it costs you, big time.
Peter Severson is a writer and public policy advocate in Colorado. He aspires to a completely impractical and nigh unattainable life of quiet contemplation in the woods.