Illness in the US, but magically, no healthcare!
April 11, 2014 5:58 PM   Subscribe

I just returned from West Africa and have a number of symptoms consistent with malaria - or the flu. I have no healthcare, through circumstances beyond my control (I'll elaborate) until May 1. When is it worth it to go to the doctor to get tested? How can I try to keep this from being a pre-existing condition, given that it may be the recurrent form?

I was in West Africa for about 10 months in a malarial environment and got back to Ohio about two weeks ago. I was taking prophylaxis, but stopped about a week ago. Starting on Sunday, I've had recurring headaches, body aches, fever, chills, general fatigue, and sweats, usually lasting about half the day and interspersed with feeling pretty perky for the other half of the day. The highest fever I've recorded this week was 102.9; I've also been down to 98.3 during times when I feel good. Ibu profen levels the fever down to around 100, usually, and controls the muscle aches. This could conceivably be just the flu, or malaria. I find the timing suspect if it is just the flu, but I did a lot of international and domestic flying, too.

Due to a registration issue, my university canceled my health insurance during spring semester without notifying me, although I signed up for health care for the full year. I didn't find this out until Tuesday, which was after the Affordable Care Act closed. I registered for short term health insurance as of Wednesday (April 9) through Blue Cross blue Shield, but it turns out it doesn't go into effect until May 1. My university health insurance kicks back in on May 5. They are not interested in pro-rating me this month. Normally, my advisor would be all over this, but he's at a conference in Canada and I haven't been able to get in touch with him. He gets back sometime next week?

The infectious disease specialists have not been helpful, and are not interested in letting me skip a visit with a referring physician despite my sketchy healthcare situation ("We don't just GIVE blood tests to everyone who thinks they have an infectious disease!"). Right now, I'm feeling pretty miserable and would really like to get treated, but I don't want to have some sort of giant recurrent malaria pre-existing condition following me around for the rest of my life. Looking at the application for short term coverage, it says "to start April 10," but it's not confirmed that I have it yet. Can I use that at a doctor's office or hospital? Any other thoughts? Currently, laying on the couch with two gallon jugs of water on either side of my face because my face is really hot, waiting for my boyfriend to bring me a new thermometer.

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posted by anonymous to Health & Fitness (19 answers total) 2 users marked this as a favorite
My thought is, you do have healthcare. You don't have insurance. So, you pay the total cost out of pocket.
posted by Houstonian at 6:11 PM on April 11, 2014 [2 favorites]

Fever and chills half the day alternating with feeling much better for the other half of the day? Those are pretty classic malaria symptoms. If I were in the field I'd start on a course of coartem, but since AFAIK you can't get that around here I would go to the emergency room.

You don't want to wait on malaria. As it progresses, it gets worse. If you begin treatment early your chances of survival are much higher than they are if you try to tough it out.

Go to the emergency room. Explain to them that you've been in a malaria-endemic environment and that you have been having recurring fevers for the last six (!) days. Insist on a blood test.

It really sounds like malaria to me. You know as well as I do that malaria kills more people per year than any other disease out there. Don't fuck around or worry about your health insurance, get it taken care of. Apply for financial assistance through the hospital later if you have to.
posted by Scientist at 6:19 PM on April 11, 2014 [15 favorites]

Go to the doctor. You've been spiking temps for a week and the highest was pretty high. Whatever type of infection it is, your body is having a hard time fighting it and something's gonna give. I get your hesitation but at some point the benefits of taking action outweigh the costs.
posted by pintapicasso at 6:22 PM on April 11, 2014

Get yourself treated first and deal with the financial consequences later. Your long-term health, and even survival, are way more important than hypothetical future coverage problems.
posted by plastic_animals at 6:23 PM on April 11, 2014 [3 favorites]

The university cancelling your insurance, unless you no longer qualify to be on their plan (or did not qualify for the plan for Spring semester), is entirely unacceptable. Contact your school's dean of students or someone similar. Tell them it's an emergency. Make a stink. There has to be someone to be contacted for emergencies related to student life stuff. Let them sort this out for you.
posted by needs more cowbell at 6:29 PM on April 11, 2014 [9 favorites]

Also, partly squamous, your situation sounds horrible but I believe there are different types of Protozoa that cause malaria and therefore like most infections there is a range in the severity of symptoms. So, OP could still have malaria even though she is coherent enough to type this askme.
posted by pintapicasso at 6:30 PM on April 11, 2014 [1 favorite]

Travel clinics sometimes sell home tests for malaria. I've taken about ten of them. That might be a good, cheap first step.
posted by mrfuga0 at 6:34 PM on April 11, 2014 [3 favorites]

If you go to the hospital today and find it out in a month that your short-term coverage was actually active, or your advisor is able to get the school to reinstate your coverage without a gap, you can mail the hospital that information, they'll bill the insurance, and that's that. You'd be far from the only person to seek medical treatment first and figure out the coverage details later. If that doesn't pan out, there is charity care you can apply for, or payment plans you can work out. If you have a choice, try to get yourself to a not-for-profit hospital.
posted by ThePinkSuperhero at 6:35 PM on April 11, 2014 [8 favorites]

I also think you should make a stink at the university. Push higher and higher, call the dean, etc. And get yourself to a doctor.
posted by radioamy at 6:40 PM on April 11, 2014 [2 favorites]

Right now, I'm feeling pretty miserable and would really like to get treated, but I don't want to have some sort of giant recurrent malaria pre-existing condition following me around for the rest of my life.

Thanks to the ACA, that's no longer a concern. Insurance companies can't even ask any more.
posted by empath at 7:08 PM on April 11, 2014

It could also be dengue fever, btw. It could also just be the flu. You really need to go to an urgent care clinic.
posted by empath at 7:12 PM on April 11, 2014 [1 favorite]

If I were you, I'd go to an emergency room. An unexplained fever after traveling is a big deal, and you don't know if or when you're going to take a sudden turn for the (much) worse.

-- Try to go to a not-for-profit or non-profit hospital. Most hospitals aren't private, so you should be able to find one nearby.

-- Give the ER intake person whatever insurance card you have (for the short term insurance?). If you don't have insurance, they'll still treat you -- don't worry too much about this right now.

-- Fill out the hospital's financial aid forms. If they ask you if you want to fill out those forms, great, but if they don't, just ask for the forms yourself.

-- For Rx, you might want to tell the doctor that you don't have insurance/are broke, and ask if there are generics. I don't know if that matters so much, but I try to do that because I know that doctors usually don't think about how much prescriptions cost unless you ask them about it.

-- Eventually, you'll get billed for whatever your insurance doesn't pay for. Even if you have insurance coverage now, if you're just treated and not admitted, it's very possible the visit won't cost more than your deductible and you'll be charged for the full amount anyway (yet another reason not to let lack of insurance coverage keep you from the hospital). If that bill is too high for you to pay, call the hospital's billing department. You'll probably be able to at least work out a payment plan, and if your financial aid documents show that you really *can't* pay (which I suspect will be the case, since you're a student), you're likely to get the full amount waived.

This is all based on my personal experience -- last year I tried to wait out and/or home-cure a "weird" sickness that turned into a kidney infection, and I wound up in the ER, feeling worse than I have in my life, with shitty individual/catastrophic plan insurance and not much money. I ended up paying about $200 for the ER visit and about $50 for Rx (on the spot). The hospital originally billed me about $3K, but they waived it once I called them, told them I was broke, and turned in my financial aid forms.
posted by rue72 at 7:45 PM on April 11, 2014 [2 favorites]

I've had malaria after taking a profylaxe, resulting in a mild attack. My symptoms were pretty much exactly what you are describing. I felt fine every morning, then at noon the fever and aches returned.

I had pain in my kidney area and a weird headache that moved to whatever part of my head touched the pillow, no matter how soft a pillow I used. It also hurt to turn my eyes. These symptoms may or may not sound familiar to you.

My malaria was not detected by a home test. But when a doctor tested me, he was very sure that I had it. It was the Tropica variety.

From my experience and your symptoms, I believe 100% that what you are experiencing is a mild malaria attack, that's weakened by the profylaxe you took. It's still malaria.
Do not wait to get it treated. This is a disease that kills many many people. Raise a stink about insurance, yes, but first of all get treated.

For what it's worth, I was treated with artesunate during my attack and the malaria was gone for good. I'm cleared to donate blood again.
posted by Too-Ticky at 12:49 AM on April 12, 2014 [4 favorites]

Just to add that if your malaria is treated it will be completely eradicated, and would no more count as a pre-existing condition than say, chicken pox. Malaria isn't a chronic condition unless you live somewhere where it is endemic and you are continually being re-infected.
posted by tinkletown at 9:49 AM on April 12, 2014 [1 favorite]

Try to go to a not-for-profit or non-profit hospital.

This is a little off-topic, but in terms of how much the care will cost or how aggressive or difficult they might be to work with in terms of payment plans and collections, for-profit vs. not-for-profit doesn't matter.

I've worked in hospitals for a decade and a half, and it is very difficult for the layperson to determine which hospitals will be more expensive. In my area, the smaller, non-profit, community-based hospital is by FAR the most expensive in the area, is very aggressive about self-pay collections, and will not work out payment plans (they require you to get a third-party loan in order to make payments). In contrast, the for-profit hospitals I have worked at that are part of a huge national chain were average in terms of charges and were reasonable about payment arrangements.

So don't get hung up on trying to figure out the tax-exempt status of the place you go to. Just heed the advice and go where is convenient or otherwise preferable to you.
posted by jeoc at 6:10 PM on April 12, 2014

Mod note: From the OP:
Good morning from the hospital. Admitted yesterday for malaria treatment, as well as taking care of a bunch of things which are out of whack. I really appreciate everyone's concern and clear headedness at a time when I was pretty fuzzy. Hopefully I'll be discharged tomorrow.
posted by taz (staff) at 3:50 AM on April 13, 2014 [6 favorites]

Sorry to hear it actually was malaria, but glad you're getting help.
posted by ThePinkSuperhero at 11:13 AM on April 13, 2014

Glad you're getting treated. Malaria zone + fever/symptoms you were having is malaria until proven otherwise.
posted by gramcracker at 4:14 PM on April 14, 2014

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