Patient Story

If an appendix explodes in the woods and nobody hears it…

Deep in the Sierra Nevada’s while installing a metal roof onto a tiny house, a thirty-something man starts to feel a pain in his stomach. 

This thirty-something man is me. Hi – I’m Professor Hoiland, and my appendix exploded while I was off the grid and off the map. This was pre-Affordable Care Act, back when insurance was a nice thing to have, but not required. I mean, hell, I was a healthy dude and wasn’t making enough anyway to rationalize buying health insurance. Figured I could just rub dirt it in or cover it in super glue if anything bad happened – and bad things happened often while building that tiny house.

You can’t really rub dirt in it when it’s something on the inside that breaks, so I slouched my way to the country hospital in Grass Valley and checked myself into the emergency room. I started by saying, “I don’t have insurance, but I think I’m dying.” I’m glad they respected this, because the ER doctors were straight up with me. 

“Look”, he said, “we’ll need to run a CT scan to be sure, else we’d be cutting you open for nothing. It’s not cheap – might cost you $3-5k just for the scan. You cool with this?”

At each stage of triage I started adding the dollar signs in my mind. Four grand for this, a couple hundred for the doctors, a couple hundred for the pain meds. I even did a quick google for “average appendectomy cost” and learned that the national average is about $2,500. Kinda sucks, but not as bad as I thought. I figured the CT scan estimate the doctor gave was bloated just to be safe. I could do $2,500 – might have to skip a few years of buying nice things, but I could manage.

The scan came back affirmative and they decided to cut me open.

It actually went surprising well for a small country hospital. They were professional, fast, and clean. I woke up shortly afterwards feeling great and was on my feet again within an hour with three new holes in my belly and a fist full of Vicodin. I asked to see the bill, but was told that I should receive it in the mail within a few weeks. Nice! I get to walk out of the hospital with the pocket cash I walked in with!

A few weeks later I drove to town to pick up my mail and found the bill from the hospital. It was a thick letter, and intimidating. Inside was a highly detailed line item bill for their services. Surgeon fees, ER fees, hospital fees, laparoscopic scopes, needles, knifes, bed sheets – everything was listed, each with a price beside it. And at the very end, the total price: $45,000. I probably didn’t breathe for 5 minutes.

I called the hospital to make sure I was reading this right. They said no, because the anesthesiologist was a contractor and will bill me separately as will the imaging technician. “Expect around another 4 to 5 thousand for those”. Of course I didn’t have this money, so I asked about my options. They mentioned a low-income form that may subsidize my total cost to around $25,000. Still not low enough. 

I asked about the $2,500 national average for this service and learned something fascinating: What the facility bills, and what they receive varies drastically. “Some insurance companies have a flat-fee for appendectomies and may give us $600. Others may pay out close to $5,000. It actually costs our facility the price we billed you, but we try to average it out across services and insurance claim payouts. It’s messy.” Their honesty was refreshing, but I was nevertheless still in their debt.

Years later I still have this massive medical bill on my credit. It’s still hurting my ability to qualify for good interest rates on home loans, keeps my auto insurance rates high, and replaced the physical pain I once felt in my stomach with another pain of financial irresponsibility.

So today I ask, #WhatTheHealthCare?