Bugging Your HMO!
Q: Ive been
suffering with intestinal distress ever since a trip to Peru. But my health maintenance
organization wont do any further testing. How can I get parasite testing with
the HMO picking up the tab?
A: I feel your pain. Literally. Two
years ago I was in your position, as were several of my friends. Let me tell you my story
of parasite woe, and then well talk about solutions.
It was my bachelorette party, and my seven closest friends and I were
bonding over a luscious chocolate-and-fresh-raspberry dessert. All went well. I got
married two days later and went on a brief honeymoon. It wasn't until seven days after
consuming that dessert that my intestines went haywire and didn't let up for weeks.
After a week or so of figuring I had a particularly
nasty stomach flu, I started e-mailing and calling my friends, and each one had the same
symptoms. By the time I got to the fourth sick friend, I called the local health
department and told them I thought I had an outbreak on my hands. I could sense the
public-health nurse on the other end of the line smiling a knowing smile, gesturing to her
co-workers that they had another conspiracy theorist on the phone. But she began to take
my story more seriously as I described my friends (who live all over the country) coming
down with the same symptoms and having this one dessert in common. Cinching her interest
was a newspaper clipping from the previous week announcing a new outbreak of the parasite
cyclospora on you guessed it fresh raspberries.
As it turned out, seven of the eight of us ended up
sick. And it was interesting to note how differently we were all treated by our medical
providers. My HMO doctor diagnosed me over the phone with stomach flu and said to check
back if I had blood in my stool. That never happened, but the bloating, diarrhea and
pain continued for weeks. By contrast, the public-health people asked me to
give an immediate stool sample to the state health laboratory, where technicians were
experienced in identifying this unusual parasite that had wreaked havoc all over the
United States the previous spring. My sample came up positive. I called my doctor's office
back, gave them this information and eventually got a broad-spectrum antibiotic that
promptly knocked the beastie out.
But my friends werent so lucky. A few suffered
for six weeks before they could convince their doctors that they had a serious, if
unusual, illness. One friend, a tough-as-nails newspaper editor, called me in tears
after her HMO doctor refused to give her antibiotics, convinced she had malaria, of all
things. Because my friend knew that I'd had a positive test for cyclospora, she asked
specifically for a stool sample to be checked for the bug. The sample was taken, but
they didn't check for cyclospora. When the negative result came in, they told her
there was nothing wrong. And besides, they said, the doctor couldn't see her again
for three weeks. Meanwhile, she was missing work and suffering through social
engagements, where the sight of anything but plain rice turned her stomach to goo.
Ultimately, most of our illnesses were pinpointed by
public-health departments. In part, that was because we had an official outbreak that was
being investigated by public-health officials, and they needed as much evidence as
possible. It would have been nice if our doctors had been more aware of the cyclospora
outbreak, but then the chances that they'd actually come across a case were pretty low.
In your case, you're on your own so it might be
difficult to get local health officials to test you, unless you have good evidence that
you're part of some outbreak. It's worth a try, though call the local or state
health department and ask for someone who handles infectious disease outbreaks. They might
have advice about your symptoms and what they might mean.
Another option would be to contact a local university
medical center, which might have a department specializing in travel medicine
diseases people pick up in other countries, or shots they need before they go on a trip. If
your HMO doesn't have a relationship with the clinic, you might have to pay for a visit
out of your own pocket. It could be worth it to identify whatever bug is ailing you.
Keep in mind that it's hard for any doctor to know
whether diarrhea or other intestinal problems are caused by stress, a common virus or some
exotic bug. The best clue, unfortunately, is time. If you are sick for more than a week,
or have bloody stool, then it's time to pressure your doctor's office and/or HMO for
tests. If you encounter resistance, work your way up the ladder of responsibility, from
your doctor's office to the HMO's customer-service people to the plan's medical director.
Not everybody with diarrhea needs an expensive battery of tests to look for exotic bugs,
but if you have long-standing symptoms and a reason to think you might have something
weird, don't hesitate. As we found out, you may have to fight to get help evicting the
bugs that have taken up residence in your gut.