When I came home last night from refereeing a good soccer game, my son was still up. It was way past his bed time. He was busy being a happy but tired toddler when he saw me.
“Daddy home, JayJay bunny, bunny jumping on Mommy and Daddy bed, Daddy home!”
He does know how to be adorable as he attempted to avoid brushing his teeth. The offer to join him in being a bunny was his best alternative to brushing teeth. Unfortunately, I’m usually a responsible parent, so the tempting offer was declined. We brushed teeth, sang a song, and he went to sleep fairly quickly.
On a typical night, this would be unexpected only for the time of night. Last night, it was unexpected because he had been sent home from daycare for throwing up, a fever, and odd breathing sounds. I thought he just had daycare crud. Daycare crud’s typical treatment is rest, hydration and lots of lap time. I picked him up after I left work, and we spent the afternoon watching Team Umizoomi, napping, and drinking apple juice.
And then my wife had several points of near failure in the medical system last night.
We had talked to the pediatrician’s nursing line, and the nurse listened to our symptoms and concerns. She agreed it sounded like a mild viral infection, so rest and apple juice was a good regimen. We were attempting to utilize the lowest level of care that was appropriate. However, his breathing became more labored in the early evening, so my wife texted me to confirm that there was a $50 co-pay for any urgent care visits. Our ER co-pay is $75 and it is waived if there is an admission.
She made it to the urgent care with 20 minutes to spare before it closed for the night. She checked in, and within thirty seconds, the nurse had JayJay going to a treatment room as well as getting the physician assistant out of a strep throat examination and hauling ass down the hallway. Evidently, JayJay was in significant respiratory distress as the day care crud was actually a slow moving mass asthma attack.
There was a shot, screaming, a promise of ice cream, a nebulizer therapy session, a dose of steroids and a big list of prescriptions. The doctor told my wife that if JayJay did not respond favorably in the first couple of minutes to the shot and the steroids, he would have called an ambulance for an emergency admission to the local pediatric hospital. JayJay thankfully responded well and started to play while hooked up to the nebulizer.
When my wife picked up the prescription list, she was supposed to get a one way valve chamber for the inhaler as a 2 year old can’t use an inhaler well. She did not receive it. The pharmacist never asked about it, and my wife thought that she had received everything she needed and brought the kids home with her. I arrived home shortly after that.
His treatments at the urgent care will probably cost my insurance $400 or $500 and the prescriptions another $150. We’re just responsible for the co-pay as urgent cares are seen as an emergency room diversion, so they don’t count to deductible for my company.
As I was putting the kids to bed, my wife was on the phone trying to get the one way valve chamber from the same pharmacy where we got three prescriptions forty minutes ago. Finally, the pharmacist realized the one way valve chamber was on a different page of the electronic prescription screen, and said it would be available for pick-up, so out the door my wife went.
JayJay slept well enough overnight, even as he received two treatments while he was still asleep. He’ll stay home today and see his regular pediatrician by lunchtime and then get his ice cream and playtime with mommy.
Besides hooking myself up to a caffeine drip this morning, I realized how lucky we were last night as there were at least two points of near failure in the problem of delivering appropriate, effective and reasonably priced care to my son.
The first point of near failure was the co-pay almost deterred my wife from taking him to the urgent care clinic. $50 is something that we can handle, thankfully, but it is a strong stop and think number. $50 means, for us, we don’t take the kids out to dinner this week, it is not a budget breaker and it is not a crisis. Three years ago, $50 was a painful choice, and five years ago when I was unemployed, $50 was a potential crisis. Trying to save $50 probably would have led to an emergency room visit later last night as he would have started to turn colors. Once everything was done for him at the ER, we would probably be looking at $2,000 in contracted rate charges. Waiting and seeing would have been a $1,000 bill between deductible and co-insurance for us, and a $1,000 charge for my company.
The second point of failure was a miscommunication between the provider and the pharmacy. We should have received the one way valve chamber device initially, and it was prescribed initially. We got it as my wife was able to drive 20 minutes at 11:00pm and get it. If we did not have a car, we would have been screwed as JayJay would not have received anything close to an effective dose on his overnight treatments. The lack of a $14 piece of plastic could have led to a $2,000 ER visit.
We got lucky last night. We have resources of money, a working car, and shared parenting so one of us could get the kids asleep while the other one spent an hour fixing a mistake. A high first dollar health plan (which is where the entire US system is going) for parents’ who lack one of the above conditions would have made a scary but very fixable situation into a significant crisis on the medical and financial side.