robi2106's Journal: Allergy Wars: Part Deux - Pain in the Wallet

(NOTE: Updated with more sarcasm 2006-11-03-1045hrs)
Today's doctor's visit cost $758. Another $173 for the Doctor's time, $457 for the future lab work (blood draw and lab tests), and $128 for the percutaneous poke test (of doom).

The preliminary results of the percutaneous poke test are only indicators of very bad allergies and not mild allergies. Mild allergies might not show up on the poke test, but would show up on either of the in depth test batteries (more on them later).

The poke test involves plastic fork looking devices. Think of a normal plastic fork, or spork if you will, but think of it as an evil spork and then think about it dipped in poison. Multi-colored poison (of doom). Each fork has 8 of what I like to call "annoying pokers" arranged in two long rows. Each poker is a ~2mm x 2mm extruded plastic piece (like a pencil) with 8 needle sharp plastic points arranged around the square end.

The tech / nurse takes each evil spork out of its sheath (skull & crossbones optional but advised for any evil medical apparatus) which has each annoying poker pre-soaked in different vile substances or allergens known to cause adverse reactions in upper twenties java programmers (mold, dust mites, cats, grasses, household chores, writing documentation, etc) and then the fork gets pressed against the skin. It doesn't really hurt. It just kind of pricks you. Then you wait.

Five minutes, nothing. But between 5-10 minutes my skin boiled up like massive mosquito bites under about 1/2 of the 16 pokers. Oh Fun. The nurse takes a plastic device that looks like a protractor and measures the diameter of each boil (itching relative to its size I assure you) and takes notes with remarks like "spot #B2 must itch like hell" and "spot #A2 - Ragweed? What is that? Some sort of plant or lettus thing? That reminds me, I wonder what's for dinner?" She checks (the spots not her dinner) again at 15 minutes and notes the spread of the killer lumps (of doom).

So that is a percutaneous poke test in a nutshell. By this afternoon the welts have pretty much disappeared, but little red poked parts are still visible.

According to the medical tech (nurse, LPN, torture artist, whatever they like to call themselves) I have allergies in the top 30% of worst cases she has seen. Joy. The dime sized welts developed over 15 minutes with the poke test say that I have very sensitive allergies to the following types of substances in decreasing order of sensitivity (but all are in the very sensitive category):

Johnson Grass
Grass Mix
Fall Pollen Mix
cats
ragweed
dust mites
oak pollen
cedar pollen
dogs
manual labor & cleaning toilets (ok, possibly not that. But my wife will roll her eyes when she reads that part and I love doing that to her :-P )

Blood for food allergy tests was also drawn using fancy vacuum sealed tubes. Just poke the skin with a needle, poke the other end of the needle through the rubber seal, and WOOOOSH out goes your blood. Modern technology. Hence the insanely expensive $457 lab fee. Speaking of blood draws, this was my first blood draw ever. Yeah, I'm a stingy 'ol cook when it comes to my precious bodily fluids. What can I say, I grow attached to those 'lil platelets and T-cells and just haven't wanted to give them up. Besides, I always guessed that my blood contains caffeine levels known by the state of California to be dangerous to young children, the elderly, and small animals (why would they need my blood any way).

After the lab fee, you sit with the RN-LPNN....N (whatever) to decide which treatment plan to go with and discuss environmental mediation steps (kill the cat, your neighbor's cats, stop huffing the front lawn, rip out the carpet, live in a plastic bubble, etc). Treatment supposedly actually treats the body's immune system problem for good.

Treatment is a 2-3 YEAR process where antigens are introduced along with the chemicals needed to stimulate the body's normal fighting mechanism. The doses increase until the body is fighting the antigens on its own, and then the treatments are maintained till being phased out. There are two treatment options and the desired option determines which in depth test is performed. After looking at the prices below, you may think as I have that I may be on to something with that free cat reduction policy.

Option #1 is a daily liquid drop. That associated test costs $200-300 and the drops cost about $80 / month. This test & treatment is usually NOT covered by insurance (according to the nurse) but cost less in the long run.

Option #2's test & associated treatment is a weekly shot ($35) taken from vials that are mixed to specific amounts determined by the body's reactions. These vials are mixed every 5-7 weeks and cost $135 to mix (in addition to the weekly $35 shot). The associated test for this treatment costs $800-$1,200 is is usually covered by insurance (though High Deductible Health Plans - HDHPs - do not usually cover anything until the deductible is met).

So when combined with last weeks $170 doctor visit plus $160 in prescriptions, I have racked up $1088 in bills and I have one more visit for sure (get the food allergy results back and go over environmental causes) in two weeks.

Looking at the two options, lets run the numbers. Option #1 might cost up to $2880 to treat and another $300 to test. Combined with the every 3 month checkup by the doctor (another $170 / visit) that hits $5220 over 3 fiscal years. With that cost and 3 years deductibles ($2K / yr) I will not likely hit any years deductible except this years (for the testing and office visit thus far).

Option #2, the shots, will cost $1200 to test and up to $6276 to treat totaling $8316 over 3 years with the same doctor visits thrown in. This touches 3 calendar years and may hit the deductible for each year.

Now factor in the $80 / month for a HDHP + HSA account totaling $2880 in premiums each month for three years. So my options are at a _minimum_ either (including current office visits) $6478 (drops) or $9574 (shots). This does assume that I stick with my current HDHP instead of switching to a lower deductible plan. I know one has a $1k deductible but costs $120 / month. But that plan covers a LOT more and may be worth it. Of course having just had a diagnosis for allergy problems, I would probably not be given as cheap a plan (being a higher risk with assured health claims against the plan).

Treatment is, of course, still optional. I can just work to eliminate the causes with environmental mediation and not go through either treatment. I can replace all the carpet in the house with good laminate floating floors in the high traffic areas and carpet in the bedrooms for less than the price of any treatment option. Then consider the $200 for a short stock .22 threaded barrel rifle (threaded for a suppresor for the Free Neighborhood Cat Reduction Plan) and another $200 for the Federal SOT license (for the silencer). Toss in a full coat of paint for the house and treatment still costs more. But then again, treatment is supposed to be just that.... treatment. Finished and complete, not just masking the symptoms. But the other plan gets me a kick ass gun with a Federal Class 3 license and a silencer. Hummmmm tough choice.

Given the choice, which would you choose? Bonus points if your choice can involve both treatment, the gun, AND some ice cream on Fridays.

Allergies

[Jaguar777]

My wife has allergies, and she went through all the tests you just described. Her tests came back a little more extreme than yours. We decided to go with the best insurance(read:most expensive) my employer offers, and it was worth it. The shot is $2.16 a week, and the vile vial mix is $15. She gets two shots a week, one for indoor, and one for outdoor allergies.

She is half way through the treatment now, and there are good and bad points. She says her head is clearer now, and she has less problems with stuff