My whopping $32 emergency room visit in the land of socialized medicine

This afternoon I went to the emergency room of the Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts in Paris, France. It's a hospital that specializes in eye problems. I had to have emergency eye surgery on the spot. With the national debate on health care raging in Washington, it seemed timely to share my story.

I wrote earlier today about yet another hellish experience with CareFirst Blue Cross Blue Shield last night. I just arrived in France for my annual house-sitting for Chris and his wife Joelle, and I noticed that I was having some eye problems - specifically, a marked increase in floaters, including an incredibly large one and some new dark ones I'd never seen before in 40 years of having floaters. I have some experience with floaters, since two years ago when they last struck I went to a retina specialist and found out that I had a small hole and a small tear in my retina that needed to be fixed immediately, lest they lead to a full retinal detachment, that can lead to blindness. My sister suffered an all out detached retina, so it runs in the family.

Judging by my history of retina problems, and knowing the signs to look for, the marked increase in floaters set off warning bells, and I called Blue Cross, my insurer to inquire what my coverage was while abroad. They were total idiots. I explain that conversation in the post I link to above. Suffice it to say, Blue Cross first told me I was covered wherever I went, then a second employee told me I would only be covered if I went to an emergency room, but not if I stepped foot out of the emergency room for emergency care.

Shrugging off the utter confusion that was the advice I got from Blue Cross, and their implied threat not to cover me if the emergency room sent me to a specialist for emergency treatment, I went to the Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, a local hospital here in Paris that specializes in eye conditions.

On first impressions, the place is no great shakes. It looks like a hospital a bit trapped in time - perhaps circa 1960 - and certainly doesn't compare to the gleaming fortresses that air American hospitals.

But.

Once you get beyond the cosmetic weakness, the French lived up to their reputation as the best health care system in the world, and the costs are cheap as dirt to boot.

I walk into the emergency room, wait ten minutes to speak to the woman at the "accueil" (or welcome desk). She takes my info for five minutes, then sends me to the cashier to pay in advance for my emergency room visit. I got to the cashier and explain that my American insurance is requiring a detailed break down of the costs, including how much for each aspect of the treatment (the doctor's fees, the medicines, etc), or they won't reimburse me. The woman behind the counter tells me all they have is the charge on the bill, 23 euros.

23 euros?

That's 32 bucks. You'll easily pay $800+ for a basic-level emergency room visit in the states. I think I stifled a laugh.

Rather than worry about Blue Cross' sure-to-be nightmare on trying to get my 32 bucks reimbursed, I went back to the emergency room waiting room and waited my turn. The sign on the wall said to expect a two hour wait, but the lady at the accueil said it would probably be more like an hour.

It was 20 minutes.

"Monsieur Aravosis," the very cute, very young dark-haired French doctor said from behind a glass wall. "Oui," I responded, raising my hand and pausing the copy of "The Last Starfighter" playing on my iPhone.

Julien, as my doctor would come to be known, asked me what was up, looked at my eyes with your standard eye-doctor eye-gazing contraption, and then had me do the standard eye test. He put some letters up on the wall and asked me to read them aloud. I asked, do you want me to say them in French? So I tried in French, kind of forgot how to say "H," and thank God there were no Js or Gs or he'd have had me pegged as blind for sure (J and G in French are pronounced the exact opposite of what they are in English), but apparently I passed. Doctor Julien then handed me some small print to read, to test my bifocal vision, I guess. I laughed - it was in French. I speak French, but still, judging my eyes by the French I read from the miniscule font on a small card while seated in an emergency room in a foreign country worrying about going blind, it just seemed awful funny. Doctor Julien then dilated my pupils, and told me to wait a bit (in fact, he gave me the medicine and had me dilate my own eyes, one drop in each eye with two different medicines, every ten minutes).

A funny thing happened while waiting for my eyes to dilate. An older man was seated across from me, maybe in his late 60s, and another doctor came out and asked him if he could help him. The older man said he was with the patient inside the other room. The doctor responded, "oh, are you his husband, or his father..." The old man responded, "he's my son." Both the doctor and the old man took the suggestion of the old guy's gay-ness in stride as if nothing happened. I imagined my own father if the emergency room doc were to ask him if he and I were a couple.

After fully dilating, Doc Julien sat me down, took another look, and confirmed that I had a rather large tear in my retina. I needed immediate laser surgery to cauterize the tear, or it would likely lead to a fully detached retina, major surgery, and possibly blindness.

You don't have to hit me with a 2 x 4.

I told Julien I'd do the surgery, then asked him "you are a doctor, right?" He laughed and said yes. I then asked, you've done these before? All the time, he said. So we went to the room with the laser and Julien and another doctor took me through 45 minutes of living hell. Not hell because of their skills or the facilities or the equipment. Hell because someone has their hand on your eyeball for 45 minutes, while zapping your eye with a really hot laser that hurts like hell. Definitely not for the feint of heart. But it had to be done.

After clutching the desk in front of me for an hour, worrying that I might accidentally blink and slice my eyelid in two like some James Bond movie reject, it was over. Julien and the other doctor explained that I had to come back in a week, that there was still a risk that the cauterization might not work, and that if that happened, I could be facing a detached retina. Lovely.

Julien then told me to look out for any flashes of light, dark spots in my vision, or loss of vision in a portion of my eye. If any of that happened, I was to come back to the emergency room, immediately, regardless of the hour - they had specialists on staff 24 hours a day, seven days a week.

We went upstairs, Julien made my appointment for next week, gave me the eye drops to dilate myself at home before coming in. Another woman told me that the emergency surgery, with two doctors working nearly an hour, was going to cost me a grand total of 100 euros, or 140 dollars (really only 100 dollars if the exchange rate weren't so out of whack). Added on to the basic emergency room visit and consult fee of 23 euros (32 dollars), that meant my emergency room visit and emergency room surgery came to a grand total of 172 dollars.

I started to leave, then turned around and suddenly realized I hadn't paid the $140 for the emergency surgery. Do I pay the cashier, I ask the woman behind the desk? Nah, she tells me - just pay it next week when you come back for your check up.

And that, my friends, is the "nightmare" that is "socialized medicine." We should all be so lucky.

PS For comparison sake, I believe my emergency room visit for slicing the tip of my finger off cost around $800. They simply cleaned out the wound and bandaged it up, no stitches.