Saturday, November 10, 2012

Health Care Costs

In the US, health care reform has been a huge topic of debate for literally decades. Despite it being a "big" issue for years,  both employees and employers have been seeing dramatically rising health care costs year over year. We have been lucky enough not to have had really serious health issues that have mired us in the health care system so we were a bit sheltered from just how broken things are.

Living in China the last 4 years we have been a bit shielded from what has been going on here. With international insurance, we paid 25% of almost all costs (ex hospital stays which insurance covers more fully) and insurance paid the rest. We decided which doctor to see, in which country, and when we needed to go. Our doctors decided what tests and medicines were needed. We typically paid in cash and then got reimbursed. This plan worked well from our perspective. There was no "in system" versus "out of system" doctors and deductibles Since we paid up front then submitted insurance was not involved in treatment plans or medication.

We moved back onto US health insurance Sept 1. (We would not be surprised if I have blown the actuarial forecasts for costs this year, my experience is clearly unforecastable!) The insurance is so complicated Chad has had conversations with key people on the P&G Benefit Team and at the hospital.

The first bills have started to roll in and it is not hard to see how horribly broken the system is now that we are so immersed in it. The first bill to arrive was for my first night at Christ Hospital where I had blood and platelet transfusions. I shared a room, and did not see a doctor the whole time. Also, my nurse did not have her bachelor's degree.... she was a trained RN but was going to school to get her Bachelor's in Nursing. Point being I was not seeing "expensive" people, I was only there for about 14 hours and consumed a very small area of space. The bill came in for something like $12,800. Insurance paid about $2500 and the rest was "discounted".

So in our very warped health care system the hospitals charge exorbitant rates to patients with insurance to try and skim money to cover the cost of indigent clients. Then the insurance companies basically pay what they think is reasonable and they leave it at that. Both parties know this is how it works and it has persisted. It really bothers me as a Finance person to see such a broken pricing system!! I think even $2500 a night is crazy. We have stayed in extremely nice hotels around the world with much larger, more luxurious rooms, significantly better food and service for a fraction of that cost. If I had had to have any tests or seen doctors could see it being higher but this is crazy.

In my treatment, insurance has also played and active factor and we realize they are a behind the scenes part of the team. There are some medications they cover and some they only cover if you are outpatient, and some the team here has to put a defense together for to justify. One example is I get a shot once daily to stimulate the production of white blood cells. There is a long lasting version of this shot that you get once and it lasts for 14 days.  However, insurance does not cover it inpatient even though the long lasting version is cheaper if a patient needs it for more than 7 days (I've been on it for 3 weeks now) and better for patients (less shots).

As we talked about going home and moving from IV to oral meds insurance came up again as a key consideration. A special appeal had to be made because of my prolonged low white counts to get me the drug that is most effective in my situation, but is typically not covered by insurance.

I am a full believer in the need for checks and balances in systems, but am really uncomfortable in how this system works. I have not spoken to anyone at the insurance company. They do not join on rounds so am troubled by the clearly active role with decision rights that they play in the medications and testing I am receiving yet they are not as close to my case as my doctors and his team.

So the hospital bill reconciliations have started. The system is crazy and broken. I am still ready to get home as soon as possible. We are still targeting for Monday.  Unfortunately all my counts dropped today. I am getting 2 units of blood this afternoon. I am a bit nervous about it because it is the first transfusion I will have had since I had an allergic reaction on the last one so will likely get pre-medicated with Benadryl. I was also very surprised my counts were down because I felt really good last night, and yesterday everyone felt sure at least my white blood cells would continue to trend up.

My sister, Molly, is in town for the weekend and we had a sleepover last night which boosted my spirits, so that may be why I felt better. Molly is kind enough to be coming back for another hospital sister sleepover tonight. She thought the fold out chair bed was way more comfortable than camping out so not sure if this is a sign that my family tends to have a positive view on things or if we have all had broad experiences that truly include worse options, or both.

Sorry I have rambled on a bit today. Hoping my counts start to trend back up tomorrow and Monday so I can finally go home. 

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