Tag Archives: healthcare costs

Questions… and gratitude.

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.

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Can we make it about care again?

I thought about writing about the Diabetes Research Institute’s recent BioHub announcement, but there are already several excellent posts written on the subject. Instead, I’m going to put this piece up for you to consider. Sorry if it seems like I ramble a bit here… this is a multi-faceted subject, and it’s hard to concentrate on one part of it while ignoring everything else. At any rate, I hope this gives you something to think about, and I hope it gives you a little bit of a break from all of the DRI posts this week.

Over the weekend, I heard a rebroadcast of an interesting topic on Diane Rehm’s excellent radio show. It was about healthcare in the USA since the Affordable Care Act has been passed, what we can expect once a large slice of the law takes effect in 2014, and how the law itself doesn’t address the high cost of healthcare in my country, and why. Her guest was Steven Brill, who wrote a cover story for Time magazine on the subject. It’s a really good show and a great story, if you want to check it out:

Show: http://thedianerehmshow.org/shows/2013-03-03/us-health-care-costs-rebroadcast

Story: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

One of the points made by Mr. Brill on the show is that he believes that Medicare works pretty good for seniors (compared to the plans most of the rest of us deal with anyway), and most of all, it holds down costs. As a result, he thinks we might be better off if we just allowed everyone the opportunity to enroll in Medicare. I don’t know if this is a great idea or not, but it got me thinking.

Why do I care about this? To begin with, Medicare is where I’m headed in another 15 or 20 years. Also, it’s where you’re headed in the future, if you’re not there already.

So I thought I would look into it. I can’t say much with regard to whether Medicare’s costs are low or astronomical, but there is evidence that the rate of increase in costs for Medicare is nothing compared to the 97 percent increase in insurance premiums Americans have seen since 2002.

When it comes to what Medicare covers, and what it doesn’t cover, there’s a little more documentation. But surprisingly (my skepticism of government-run programs is legendary), there’s a fair amount in there for Seniors With Diabetes (SWD).

For instance… when you’re newly diagnosed, Medicare approves 10 hours of Diabetes self-management training in the first 12 months. Also, you get this training if you’ve already been diagnosed, but you’re going from oral medication to insulin therapy for the first time. I got about an hour’s worth of training back in 1991. What’s covered in the training? The basics about managing your BGs, your diet, and exercise. Also, these interesting bullet points: How to adjust emotionally to having diabetes, and the use of the healthcare system and community resources. By the time I’m eligible for Medicare, I hope this includes finding online support. In addition to the initial training, Medicare recipients are eligible to receive 2 hours of training per year after the initial training. Not sure what’s covered in that.

Now, let’s talk durable medical. On the one hand, Medicare will cover an insulin pump for you and cover 80 percent of the cost if your doctor prescribes it. On the other hand, if you’re on insulin therapy, Medicare will pay for up to 300 test strips every three months. That only allows you to test about 3 times per day. It’s even worse with non-insulin taking SWDs. If you’re like a lot of Type 2s and not on insulin, Medicare will approve up to only 100 test strips every three months. But there is this little caveat, from the online guide Medicare’s Coverage of Diabetes Supplies and Services:

“If your doctor says it’s medically necessary, Medicare will allow you to get additional test strips and lancets. “Medically necessary” means that services or supplies are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice. You may need to keep a record that shows how often you’re actually testing yourself.” So there is that.

On the bright side, your insulin is covered under Medicare part D if you’re on MDI (multiple daily injections). Part D is the prescription drug part of Medicare. If you’re using an insulin pump: Your insulin is still covered, but under the durable medical portion of Medicare part B. In case you’re wondering, they’ve gotten Medicare down to 4 parts:

Part A – Hospital coverage
Part B – Medical coverage, including durable medical supplies
Part D – Prescription drug coverage

Part C – Also known as Medicare Advantage. Offered by Medicare-approved private insurance companies, Medicare Advantage Plans are a way to get the benefits and services covered under Part A and Part B. Most Medicare Advantage Plans cover Medicare prescription drug coverage too. So if you have Part C coverage, you won’t need Part A or B, and you might not need Part D either. Confused yet?

And this is where I have to jump off of the information train for now. The more I read about Medicare, the more I worry about senior citizens in this country (including my parents). Keeping costs down is great, getting coverage for everyone at a time in their lives when they may be the most vulnerable is great, but confusing them with a lot of rules and websites and documents and other things is most definitely not great. Can we make it about caring for our seniors again?

I’m going to be a senior citizen in a couple of decades. I hope by then, coverage will be more universal (there… I said it). I hope we’ll have better access to care and drugs and therapies that will help us live great lives into our golden years. And I hope care for everyone, senior or not, will be determined by need and not by politics or the size of your estate.
 
 
Here are some great resources I found on Medicare and Diabetes…

From Diabetes Monitor:
http://www.diabetesmonitor.com/medicare

From the Centers for Medicare and Medicaid Services, Medicare’s Coverage of Diabetes Supplies and Services:
http://www.medicare.gov/Pubs/pdf/11022.pdf
 
 
 

It’s a numbers game anyway.

I was looking at the Baseball Hall of Fame voting from yesterday, and immediately my analytical mind starting crunching the numbers… baseball is a game loved by statisticians, anyway… Since blank ballots submitted count against players being considered, how would the voting change if those blank ballots were not submitted (then they wouldn’t count against the player)? How many more votes do Jack Morris and Craig Biggio need next year to crack the 75 percent threshold for enshrinement?

Then, since my mind has been on D overload the past several months, I started thinking about numbers and how they relate to diabetes. We all know that numbers are important. Hemoglobin A1c, meter readings, carb/insulin ratios, the whole bit.

But let’s look at some of the other stuff for a moment. I was diagnosed nearly 22 years ago. That’s a fair amount of time, and to the best of my calculation (these are approximations only), here are some overall numbers. I’m going with very conservative counts, so the amount of stuff used and the cost of everything is likely higher than this.

– I didn’t always do a great job of checking my blood glucose. So if I calculate only 2.5 times testing on average, per day, for 8,016 days since diagnosis, that’s 20,040 BG checks. At even 50 cents per strip (which is a very conservative number), that’s $10,020 spent on test strips alone.

– I was on multiple daily injections until almost 3 years ago. For most of that, I was on two injections per day. Then I was on one per day (Lantus) for a couple of years, then Lantus plus a bolus fast-acting insulin before each meal and snack. So again, let’s go with 2.5 per day as an average, for 19 years. That’s 17,350 injections! It’s hard to gauge the amount I spent on syringes, but I’ll try: 17,350 injections divided by 100 syringes in a box equals almost 174 boxes. The average cost per 100-count box is probably in the $24.00 per box range (a quick online check reveals it’s about $30.00 a box now). I’m counting the full price here because my various insurance coverages over the years mostly required me to pay 100 percent for them. So 174 boxes at $24.00 per box equals $4,176 spent on syringes.

– I can’t even begin to guess how much insulin I’ve used over the years, so I won’t even try here. But it’s a lot. And there’s no such thing as generic insulin in the U.S., so the cost is probably a lot. Though most of the cost has been covered through prescription plans. So let’s do it this way: My mail-order pharmacy dispenses 90 day supplies of insulin at an average cost to me over the last 22 years of $50.00 per 90 days. That’s 88 quarters of insulin at $50.00 per quarter, which comes to $4,400 dollars worth of life-giving juice.

– I’ve been on pump therapy for almost three years now. I’ve got a pretty good medical insurance plan at work, so the initial start-up cost for my MiniMed Paradigm® Revel™ pump was right around $500. The durable medical supplies portion of my plan helps me pay for infusion sets and reservoirs every 90 days, and my cost is about $90 per quarter. It’s been about 11 quarters since I started on the pump, so at that rate I’m at $990 for infusion sets and reservoirs and other incidentals (the inserter, IV prep, etc). I’m including the cost for the CGM that goes with my pump, even though I don’t use it all the time.

Total cost of everything above: $20,086

That’s just the big stuff. I could go on and on about doctor visits every 90 days, cost going to and fro seeing doctors and specialists and gathering stuff that I need, and that ill-timed emergency room visit in Dayton, Ohio a couple of years back.

What does all of this make you think about? How much everything costs over time? How about diabetes burnout? Does it make you want to do some number crunching of your own? Is there something I’ve left out? Feel free to add to the conversation by leaving a comment below.
 
 
 

Really?

Okay, first rant of the new year coming up…

I’m beyond needing to order test strips. I’ve resorted to using my old meter because I knew they would be expensive right now. To explain this would take a month of blog posts, so I won’t bore you with it here. The situation is this: I have a pretty great prescription plan at work, but there’s this time, usually in the middle of my plan year (which is now), when I have to pay for everything out of pocket for a period of time. And that time is now.

Well, I decided that I really do need to order new strips for my current meter, so I told myself I would bite the bullet and order the strips. Then I found out how much it would cost:

TestStrips

That’s nearly $1.00 USD per strip, people. I guess I should be happy they only want to give me an 88 day supply this time (in case you’re wondering, 7 50-strip packages equals 350 strips, divided by 88 days = 3.98 strips per day).

I’m all for companies making a profit on their product. But I also believe in a little fair play. I know it makes me sound like a “free market capitalist”, but if you’re going to produce a product that’s so expensive, shouldn’t I have the ability to shop around for the same product elsewhere? Either from another prescription provider or another manufacturer? Or both?

I know that the manufacturers will say that their product is proprietary, and they shouldn’t have to share it, and they’re doing everything they can to “create efficiencies” and keep costs to consumers as low as possible. It’s still a test strip, manufacturers. You’ve been making and marketing test strips for 25 years or more here in the USA. I grant that accuracy is an issue, and I’m glad you’re all working on it. But can’t you just make the strips you’re already making more accurate? And can’t all of you make the same test strip, and work on making that more accurate? Sounds like that alone could “create efficiencies”.

My take: Profit away, test strip manufacturers and prescription providers. But if it’s going to cost so much for something I really need, you should be willing to show me how much of a profit there is in 88 days worth of test strips. And I should be able to search for the same product elsewhere, from multiple vendors. Trust me… I’m going to be a loyal customer for the foreseeable future. I just think that when push comes to shove, diabetes necessity should trump profit (and accessibility should too). Is that too much to ask?
 
 
 

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