When we last visited our heroes, they were traveling Gotham City fighting the shock of high M.S. treatment costs. “Holy prescription bill, Batman!” So riddle me this, my friends in the Sunshine, what do M.S. patients do when faced with the fact that their annual treatment costs may often outweigh the total amount of their annual salaries? And how do those without insurance or prescription plans receive treatments equivalent to those who are lucky enough to be insured? (Enter evil “Riddler” laugh here).
Obviously, I’m still routinely in shock from the costs associated with treating Multiple Sclerosis. When I was once on Copaxone, I was in awe with the fact that it costs over $1,700 for monthly allocations of the D.M.D. It’s been awhile since I pondered the costs of my treatment, so just for kicks, I logged into my insurance plan and reviewed my recent claims. I was most interested in checking out the costs associated with joining the Ty-Ty Sisterhood.
When I saw the claim amount from my first Ty treatment, I gasped and nearly sucked all of the air out of the room. The cost was more than two-and-a-half times that of Copaxone — $4,874! That’s over $1,600 per hour of the three-hour treatment. I understand now why this treatment is covered under my major medical insurance vs. my prescription plan.
As I walked around the Bat Cave, continuing to scratch my head in deep thought about the outrageous costs of medical treatments these days (difficult to do through that thick vinyl superhero costume); I pulled out the calculator and went to work. Much like Alfred Pennyworth in front of all the ancient computer machines in the Cave, I calculated all the costs associated with my M.S. treatments since my diagnosis in November, 2007. MRI’s, hospital stays, doctor visits, home health care visits, blood tests, and D.M.D. treatments covered more than three internet pages of information. My recent three hour MRI stint cost more than $8,000, with the injected dye alone costing almost $1,200. These costs are the amounts billed to my insurance carrier by the medical providers. In most cases, the insurance company settled on the “customary and reasonable” amount and didn’t pay the full bill; however, the costs are what they are and frankly they are just ridiculous. It’s apparent to me why our medical insurance premiums remain so high and why our health care system needs a complete revamping.
I’ve discussed on many occasions my fortunate situation to be covered by stellar insurance, reducing my prescription costs and doctors’ visits to Co-pays and my hospital costs and transfusion fees to just my annual deductible. But, we all know not everyone is this fortunate. Someone, somewhere, is picking up the bill.
Turn the volume up on your T.V. sets, kiddies. The message from the Gotham City Police is one you don’t want to miss. Here it comes: My total costs for M.S. treatments, in just nine months time, exceed $70,000. My medical stay, which launched this whole expensive process, cost over $16,000 itself. As I calculate the annual cost for Tysabri treatments alone, going forward they will total nearly $58,000 each year. I’ll need continued MRI series at $8,000 each, continued and regular neurologist visits (as required by the Touch Protocol process), plus regular blood work to rule out liver complications and to monitor white blood cell counts. My various prescription treatments are above and beyond this amount and none of these figures takes into account non-M.S. doctor’s visits, prescriptions, or diagnostics.
Gotham City remains under attack and the city’s beacon spotlight is shining brightly on neighboring Washington, D.C. where our health care system must be addressed and changed for the betterment of all of our citizens.
Batman, Robin, and even all of Gotham’s criminals together, can’t make this change happen. Only we – the citizens of America – and Persons with M.S. can make a difference. My legislators will be receiving this article. What are you doing to advocate for a more sensible health care system?
Tune in later for more information. Same Bat Time, Same Bat Channel…
Hi Kim,
I’ve been discussing some money issues over at my blog. After finally receiving the EOBs from the recent relapse care, including 5-day IVSM and around of MRIs, I got to see just how much a relapse medically costs.
Total billed: $10,550
Allowed Rate: $6000
My out-of-pocket: $700
I’d be curious to know more about your costs shared above. What was your insurance’s allowed rate or u/c? What were your out-of-pocket costs, including copays, coinsurance, and deductibles? What limits, if any, did you discover with your insurance policy?
Please share.
Hi Lisa,
It looks like my insurance provider is meeting roughly 60% of the billed costs in most cases (i.e. paying roughly $4800 of the $8000 billed rate for the MRI series). I often wonder if medical providers just boost their charges up by a percentage, knowing just what the insurance companies will really pay when it’s all said and done.
I’m fortunate. I only have to pay my $300 a year deductible for any hospital stays and/or Tysabri. When I was on Copaxone, my co-pay was $50 a month x 5 months I was on the treatment = $250.
I’m double-fortunate in that my employer reimburses ME for up to 1/2 of my annual deductible if it’s used. So, I truly will only pay $150 a year for my Tysabri treatments and any future medical stays.
I have an additional $50 a month in prescription co-pays right now.
So, annually, I expect my out of pocket costs to continue M.S. treatments as they are now to be:
$150 deductible +$600 prescriptions = $750. If you add in my $338 a year contribution towards my medical/prescription coverage via my employer, I’m a little over $1000 out of pocket annually.
I spend roughly another $1,000 annually for life insurance and travel insurance premiums (in addition to my company paid life insurance and long term disability insurance premiums).
(This is all why I consider myself to be truly blessed). I use a cafeteria plan at work, having a portion of my income deducted for these medical expenses pre-taxed as well.
So far I haven’t reached any limits with my health insurance provider, thank goodness, but I do have a call into them regarding issues with maxing out in my policy. Will update you when I learn more.
Wow you lucky duck.
So let’s assume it were my insurance company and they reduced the tysabri treatment from $4875 to $2925. Then with my $25 copay and 10% coinsurance, the cost to me would be about $300 for each monthly treatment. That would be $3600 each year out-of-pocket for tysabri compared to your reduced $150 deductible. And my 90% coverage is actually considered pretty good.
I just double checked with my health insurance provider — there is no lifetime max as long as I stay within network. There is a $1 million out of network maximum. I guess that makes me a lucky, lucky GOOSE.
I am feeling the pain you are talking about. My DS went through three surgeries in 6 months totaling over $180,000 (yes you are reading that correctly, First surgery – 7 weeks in the hospital getting healthy, surgery to remove colon and complications. Second surgery – 6 days in hospital to reconstruct a new colon. Third surgery – 5 days in hospital reconnect everything). Now add in my MS treatment.
Two Saturday’s ago I sat in my back yard with my three year old crying because I had received a $20,000 bill from the hospital in additions to the other ones I already had. I told the neighbor all I could do was sign over my house. I have since contacted the hospital and had the overall bill reduced and am filling out hardship paperwork (but don’t suspect I will qualify). Good news is I have a wonderful advocate from the hospital who is working hard to help us out, I have faith she will persevere!
You would think with my DH being a PA State Trooper that we would have better health insurance. What is a family to do with everything increasing in price, including insurance premiums and out of pocket expense.
Sunshine: I have it better than 1/3 of the American populations, I at least have decent insurance coverage.
yes, yes, yes. Ms. Fabrizio keep on this area of discussion. This has to change!!! The high cost of medical care is untenable. Everyone should have access to the best possible care when they are suffering with any illness. I know that is probably pie-in-the-sky but I do believe it may someday be possible and if it takes a socialized medicine to do it then I am all for it. Take care. Thanks for your blog.
This is majorly jacked up. I’m sticking to holistic medicine for a while though I must say that acupuncture is also costing an arm and a leg since it’s not covered by my insurance. Thank goodness all my yoga is part of the teacher training I paid for and compared to DMDs it is cheap. I called my legislator about the new ADA act. I’ll call or write again on this issue.
I started to write here about all the other out-of-sight price hikes we face … food, fuel, etc. But it was too scary to compile that list. I’ve written, too, to legislators, and ours have recently begun pressuring the administration to address the fuel prices. I think it will take a lot more letters, though, on all the issues.