The doctor was adamant. "This is America, not Sweden," he told me. "We operate."
How did this happen to me, I wondered, looking at him across the ER exam room. How could I, a health-care provider, not have insurance?
I had awakened that morning with a mildly upset stomach. Nonetheless, I'd gone to my job (begun only six weeks earlier) as a physician assistant at a clinic.
Despite crampy stomach pain, I continued to see patients until 3 p. m., when the pain became steady: on a 10-point scale, I gave it a 6. I left work early.
I hoped to go home and relax, maybe take a nap. Crawling into bed, however, I realized that my pain had coalesced in the right lower quadrant of my abdomen. Could it be appendicitis?
Panic flooded me. After six weeks at my new job, I now qualified for health insurance, but I'd neglected to fill out the necessary paperwork.
Only an hour after leaving the clinic, I returned. Almost hysterically, I completed and faxed in the insurance forms.
I felt it would look better if I didn't show up at the ER on the day I'd applied for insurance.
At 6:30 a.m., I walked to the large, prestigious nonprofit hospital located three blocks from my apartment. Waiting for the ER doctor, I recalled that, at some point in my schooling, I'd read a Swedish study about treating appendicitis with antibiotics. Googling the study on my smartphone, I found it.
By the time the ER resident approached, I was ready.
"I don't have health insurance," I said calmly. "Can I be treated with antibiotics instead of surgery?"
"I doubt they're going to let you do that here," he said. "But keep expressing interest."
They sent me for a triple-contrast CT scan. The results: early acute appendicitis.
Next I met with some members of the surgical team: a resident and a medical student.
"I'm familiar with the literature about antibiotics in lieu of surgery," the resident said, "but those studies were in pediatric patients, not adults." He turned to the med student. "We have to get the attending."
The attending surgeon arrived and heard my spiel.
"Man, you already got a CT scan - your bill is going to be huge anyway," he said irritably. "This is a simple surgery."
So many times, I'd told a patient, " don't think about the cost; that can all be worked out once you're healthy again.".
But now I realized the truth: No one involved in my care actually knew the cost of any of the treatments they were suggesting.
My phone rang. It was another supervisor from work.
"How do you feel?" he asked.
"The pain is 5 out of 10," I said. "A little less than this morning."
"Andrew, get out of there. We'll schedule you for an appendectomy as an outpatient procedure tomorrow. You'll save a lot of money."
I walked out of my room and down to the nursing station.
"I'm signing out against medical advice," I told my nurse.
She looked shocked. "Sir, please don't do this. You could die."
"I'm not going to die," I said. "If I need to, I'll come back."
I texted my supervisor, asking him to call in prescriptions for the antibiotics used in the studies. That night, I started taking them.
The next morning, my pain was down to a 3. I declined outpatient surgery. On Monday I worked a full day. On Wednesday, I got word that my insurance would apply retroactively.
Then the bills started to arrive. The full tab for an ER visit, a CT scan, a dose of IV antibiotics and hospital admission came to more than $30,000 - without an appendectomy. Two weeks later, I finished my oral antibiotics. Total cost: less than $50.
It's now six months later. I haven't missed a day of work, and I feel great.
It's easy to tell a worried patient, "Let's worry about the cost once you're healthy," but having been that patient myself, if only for a day, I know how thoroughly the fear of medical bills can obliterate any concern about health or healing.
Now, when someone asks me how much a treatment costs, I no longer get annoyed. I go and find out.