Costs, Chemo and Beelzebub

Tomorrow I go for my fifth chemo treatment.  I had hoped this would be the next to last treatment, but evidently I misheard when Dr. Vance told me how many sessions were planned- I heard six, she said eight, so we still have four to go. I’m keeping my fingers crossed that the three Neupogen  shots  last week  did their job of stimulating my bone marrow to produce more white cells, I really don’t want another delay.

Today I have been trying to make sense of the billings for all this treatment. Thank goodness I’m on Medicare and  have a supplemental  policy because  we would be bankrupt otherwise, I’m sure. There have been several  news reports and TV segments about the high cost of cancer treatment, but until you actually begin to see the bills, you have no idea!  At least, I didn’t.  And once I did see the bills  I could see how very little sense the whole medical billing process makes.

Take, for instance, my visit to the clinic and infusion center two weeks ago.  I had the usual bloodwork, a visit with the doctor, and then the chemo treatment in the infusion center.  The amount billed to Medicare/the insurance company by the medical providers was $15,130.00.  Of that amount the insurance allowed amount was $3562.95, and the amount paid by Medicare/ the insurance company was $2849.71.  My copay share is $655.09. Fortunately, because our income makes us eligible for some assistance a foundation pays a portion of that copay, greatly reducing our out-of-pocket expenses. The Neupogen shots are billed at $1243.00 each, but only  $498 of that is allowed by the insurance company, they pay $395 and my copay amount is  $95.00, so at three shots every other week,  it is really going to add up and I’m unsure whether the foundation covers a portion of the Neupogen copays.

 What is interesting is the huge discrepancy between the amounts billed and the amounts allowed and paid by insurance. The providers have agreed to the amounts paid, so there will be no additional billing to us to make up the difference. I wonder if those without insurance are also billed at the high amount and are not entitled to the discounts, or whether they can negotiate a lower cost closer to  that amount the insurance companies allow. It boggles my mind that a provider   can bill   over $11,000.00 more than   the allowed amount and then simply write off or absorb the difference or bill that amount to someone without insurance. It’s a very crazy system.  When families are dealing with the stress of a cancer diagnosis and the side effects of the treatment, the last thing they need to worry about is how and if they are going to be able to afford treatment without going bankrupt.  In fact a 2013 study reported by CNN found that “Bankruptcies resulting from unpaid medical bills will affect nearly 2 million people this year—making health care the No. 1 cause of such filings, and outpacing bankruptcies due to credit-card bills or unpaid mortgages, according to new data. And even having health insurance doesn't buffer consumers against financial hardship.” 

 I really intended to be a little more upbeat in my post tonight, but with all the political rhetoric floating around about cutting "entitlements" and social services,  with politicians  using Medicare and Medicaid as political footballs and the legislature of my own state, Alabama,  attempting to  gut Medicaid in order to  make up for massive  deficits brought about in part by their own refusal to deal with or change a ridiculously regressive and inefficient tax structure, my  upbeat and humor buttons are stuck tight and won’t work. Maybe  the oncology nurses will give me an infusion of humor along with  the Bevacizumab and Oxaliplatin tomorrow.   Although, now that I think about it,  the name Bevacizumab  always puts me in mind of Beelzebub and it’s unlikely anything  humorous can come from something with a name like that.  But hope springs, so wish me luck tomorrow.