Diabetes Blog – Happy-Medium.net

So many questions racing through my head today…

At the end of last week, I received the EOB (Explanation of Benefits) from my medical plan for my appendectomy hospital stay in September. Immediately, my eyes moved to the overall cost of my stay in the hospital, the surgery, the intensive care, the drugs.

Total cost: $25,191.74

This included various details, all laid out in my form, including $880 per day for five days’ stay in the hospital, $2,681 to cover services in the intensive care unit my first night, $7,437 in operating room expenses, $2,278 in pharmacy costs, plus nearly $9,000 in various other costs.

As I said at the beginning, there are many questions racing through my mind. I can’t stop thinking about this. How do they come up with specific pricing? Why break out the costs into so many different categories? As always, why are the pharmacy costs nearly ten percent of the bill?

Fortunately for me, I’m enrolled in a fairly generous medical benefit plan through my employer. This plan means that my cost for this stay will be something just short of about ten percent of that bill. Still very high, especially for someone who already spends a few thousand out of pocket for drugs, supplies, and doctor visits throughout the year.

Which brings me to these very important questions: What does someone do if they are not in an employment position as advantageous as mine? In other words, what does someone do without coverage, or without adequate coverage? If it’s early in the year and you’re under a high deductible plan, and you get a big fat statement like this one, how do you pay for it?

Don’t forget, acute appendicitis isn’t something that anyone plans for. Neither is diabetes. Simply reviewing my situation, it’s easy to see why families declare bankruptcy every day due to medical expenses beyond their control.

And now, the U.S. Congress wants to allow states, through the Affordable Care Act, to sell skimpy policies to so-called healthy people. For a moment, let’s put aside the fact that this would mean huge increases in rates for the insurance options available for People With Diabetes.

Instead, since this is a diabetes blog, let’s look at it from the standpoint of initial diagnosis. Let’s say it’s early in the year, maybe February, and someone covered under one of these skimpy plans is diagnosed with Type 1 diabetes, requiring insulin every day, plus the durable medical supplies, test strips, insulin needles or pump paraphernalia, that go with it.

The good news is that the plans being talked about for this kind of individual cover a lot of the cost of “catastrophic” care. The bad news is, the insurance company decides the meaning of the word “catastrophic”.

Even if they cover the cost of a short hospital stay due to DKA or something else just as serious, they’re not going to cover any of the continuing costs of regular daily diabetes maintenance. And, as we all know, daily diabetes maintenance is anything but regular.

So, our previously healthy person is now stuck with what could be overwhelming costs, and over ten months left on a medical plan that won’t pay for hardly any of it.

That’s just a diabetes diagnosis. What about something like a stage 4 cancer diagnosis, a heart bypass, or another condition? What does coverage (or non-coverage) for those look like?

Oh, I have many questions racing through my head today. And an incredible feeling of gratitude that I am one of the lucky few who can afford what just happened to me.