ER Visit

Summary: Went to the ER due to breathing pain. All tests came back normal.

Back in January, I developed pain on my right side when breathing and with certain movements. I sent a message to my oncologist asking if I should see her or my PCP. Many hours later, I received a reply saying to go to the ER.

I did not want to go to the ER because I've heard you can get stuck there for hours. I called Joy to ask for her opinion. No answer. Called Ate Rose. No answer. Called Emily. She answered! She said I should go because I might have a blood clot. Joy later called back and agreed about going to the ER.

Armed with a book, I drove over to Kaiser. It's less than 2 miles away. I did not have to wait long in the waiting room before I was called in, maybe half an hour. But there was more waiting inside before I saw a doctor. She ordered blood tests and a CT scan.

I was sent back to the waiting room to wait for the CT scan. Three and a half hours later (or maybe it was four; I got so tired of waiting and almost left!), they called me in. The CT scan requires a dye for contrast, delivered via IV. The first nurse attempted to insert the IV and failed. The second nurse took a look at my arm and didn't even try. The third nurse was confident he would succeed, but he was wrong. Finally they brought in an ultrasound to find my vein and got the IV needle in.

Then they moved me to a room and made me wait again! In the meantime, someone came in and did an EKG on me. About three hours later, I was finally taken to the CT scan room. I had asked the doctor, a nurse, and the CT scan technician if the dye would hurt. They all said no. But it hurt! Not as badly as the dye used for MRIs, but it was still painful. In fact, earlier in the evening when the nurse was inserting the IV, I was trembling so badly because I knew the dye would hurt.

When the dye was injected, aside from the pain, I had a sensation of warmth in my throat and between my legs. I have heard of this reaction before, as if you were peeing. Strange sensation.

Anyway, all my tests came back normal. Maybe my pain was caused by a muscle sprain or something, although I don't know what I could have done to cause it. I was told to follow-up with my PCP but never did.

I finally went home nine hours after arriving at the ER. The pain went away after a week or two.

Oh, the cost of my ER visit? Only $50. This was with Kaiser, and the cost varies with the health plan.

Cost breakdown:

Item	Cost
ER visit	$2,555
Doctor	$365
CT scan	$400
EKG	$23
Total	$3,343

Cost of Breast Cancer Treatment

Before I get into the costs, a little explanation of terms:

Billed amount - What the provider usually charges.
Paid by plan - What insurance actually paid. This is substantially lower than the billed rate because there is a discounted rate negotiated between insurance and provider, AKA plan rate.
Paid by me - Difference between plan rate and amount paid by plan.

This is the total cost from the time I was diagnosed until my chemo port was removed:

Billed amount: $2.4M
Paid by plan: $1.1M
Paid by me: $8,600

I didn't actually pay $8,600. I had financial help from Amgen, Genentech and Kaiser. My cost was closer to $4K.

Some notable prices:

Procedure	Cost
Chemo	$440K
Lumpectomy	$46K
Radiation therapy	$100K
Kadcyla	$436K
Chemo port	$27K

Chemo cost is interesting. Some of my infusions were Taxol only, and some were combined with Herceptin and Perjeta which are immunotherapy drugs. The Taxol infusions cost $5K, but when combined with Herceptin and Perjeta, the price shot up to $54K. 

Stanford's prices are highly inflated. Some examples:

Item	Billed amt	Paid by plan
Kadcyla (per infusion)	$91,653	$42,160
Office visit	$712	$214
Bone density scan	$1,243	$572

Price comparison among providers:

Procedure	Stanford	Kaiser	PAMF
Kadcyla infusion	$42,160	$11,410
Echocardiogram	$2,843	$962
Biopsy	$8,800		$4,200
MRI	$7,178		$3,374
Physical therapy		$104	$296

In summary, cancer treatment is expensive. Don't get sick without health insurance.