After finishing a long walk pushing the jogging stroller a week ago Monday I had sudden sharp pain on the right side of my abdomen. My first thought was ectopic pregnancy, my second was ovarian cyst, and my third was appendicitis. Then I thought, no, it's probably just cramps because I was on my period, so I decided to wait and see instead of going to the doctor. The pain was fairly intense, about a 5 or 6 on this scale:

http://shsskip.swan.ac.uk/Information/Mankoski%20Pain%20Scal..., and made me want to double over when I walked across the room. I don't usually get cramps so I called my mom to ask how bad they should be.

On Tuesday the pain was less, maybe a 4, but radiating across my abdomen. Still no other symptoms, so I decided it was probably constipation. My mother saw me double over when I got up from a chair and gently suggested maybe I really should go see a doctor. Tuesday night I noticed that if I pushed on just the right spot, there was a tender spot about the size of my fingertip that was the focus of the pain. I decided I would get it looked at on Wednesday.

So then the internal debate was whether to go see my OB/GYN since my gut feeling told me it was in that area, my primary care doctor because he's a generalist, or urgent care because it could be appendicitis. (An internet search revealed that 50% of the time there are no other symptoms than abdominal pain.) My insurance is PPO and the copay is the same for all three. I finally settled on the primary care doctor.

Wednesday morning I called my primary care, but he was completely booked until late Thursday afternoon. The nurse on the phone was too rushed to give me any advice on whether to wait or not. The pain was down to about a 2, so I was hesitant to go to urgent care. But this was the 3rd day and I'd ruled out the simple explanations. At this point my husband and mother were both urging me to go get this checked out ASAP. My mother said, "you have good insurance that covers this, so just go."

I pulled up my insurance website, and the most convenient urgent care in their network was located at a nearby hospital. When I got there, it turned out that the urgent care and ER were basically the same department -- I wouldn't have gone there if I'd known it was an ER, because I don't want to be one of those people who clog up the ER unnecessarily. There was only one other person in the waiting area, though, so I decided to stay. I only waited about 15 minutes to see the triage nurse, and maybe another 15 to see a doctor. I told him I felt a little silly being there given the level of pain, and that I'd come because I couldn't get into the primary care doc that day. The doctor said the primary care doc would've sent me to urgent care anyway to check for appendicitis, so I had done the right thing.

It turns out that the current standard of care for even a possibility of appendicitis is an abdominal cat scan, so that was the next order of business. Appearantly due to the cat scans they are now catching it so early that the surgeons have a hard time deciding whether or not to operate, or to give antibiotics a try. The cat scan would also check for ovarian cysts and kidney stones -- 3 diagnosis for the price of one, so to speak. The doctor also performed a pelvic exam, and I had a pregnancy test just to triple confirm I wasn't pregnant before the cat scan.

The cat scan ruled out appendicitis, but showed an ovarian cyst, so I was then sent for an ultrasound. The final diagnosis was a hemorragic (ie bleeding) ovarian cyst. It appeared to be in the process of healing itself, so I was told to go for a followup with my OB/GYN in two weeks.

I received excellent care throughout, but am curious to find out what the final bill will be, both what is billed to the insurance and what will be my out-of-pocket. We pay $200/month for insurance through my husband's employer. I think it is an 80/20 plan, with maximum out of pocket either $3,000 or $5,000. It's a lot of money but our emergency fund will cover it with no problem.

As a health care consumer, it really shows some of the difficulties with how to contain health care spending costs. I'm an educated person who enjoys reading about medical stuff, but couldn't easily determine whether I should be going to urgent care or not. Once there, I have to rely on the doctor to tell me whether I really need a cat scan, or an ultrasound, or whether just a physical examination will do. The doctor and hospital have to worry about malpractice, and so will tend to do more tests rather than less. There's no way to shop around and compare the quality and cost of different doctors, urgent care centers, or cat scan facilities. Because insurance is obtained through an employer who offers limited options, the insurance company won't lose me as a customer if I'm not happy with their handling of my claims. If I were in a HSA plan, who's to say I wouldn't drain it with this visit and then get in a car accident before I'd had time to build the savings back up?