Monday, January 23, 2012

On reaching a quarter of a million

In one respect, I am very fortunate in my cancer care: my insurance is excellent. Oxford, Barnard’s carrier, added MSKCC as “in network” fairly recently, a huge advantage. In addition, from the beginning, MSKCC said that they prefer to handle all referrals, so that eliminates a big hassle. Friends have battled Oxford about procedures for which the approval was mysteriously missing or denied, so far I have seen little of that. I am taking the approach that a denial is MSKCC’s problem to negotiate, not mine. (One example: I received a form denying payment for the CT scan in the hospital when I was having trouble breathing. Reason? I had had a CT too recently.)

But I do see bills, a lot of them: two or three from MSKCC each month, one for outpatient services, one for inpatient services, and a separate one for physicians, those I see and those I don’t, like radiologists and pathologists. Being a compulsive user of Excel, I maintain a spreadsheet of all the charges. The entries from December passed a milestone: more than $250,000 in billed charges. Of that, I have had to pay a little more than a thousand in physician and pharmacy co-pays. Over time, I see what Oxford pays. The fraction of the nominal charge varies hugely, typically between about 55% and 90%, but occasionally a lot less.

What accounts for the quarter million? The initial surgery was about $60K, two subsequent hospital stays with IR procedures roughly $40K and $50K. The bi-weekly Avastin infusion cost about $11K (the drug itself $9802; the other drug, Afinitor, was “free” as part of the clinical trial), and the more recent weekly Torisel infusions about $4K (the drug $2334.)  So it adds up.

So in this early phase of 2012 Presidential politics, I think about health care costs. I don’t think my numbers are atypical. Perhaps MSKCC is a bit more expensive than elsewhere. I think about the unemployed who have lost their insurance, and of all the underinsured. No wonder people go bankrupt and lose everything when a family member gets sick. How awful to be seriously ill and have no idea how you will pay for the care you need. But I also think of broader policy. Can our society afford to pay a quarter of a million dollars, if the likely outcome is not a cure, but instead prolonging life by a few months? (Please note: I am not about to forego treatments for this reason.) Finally, I know that a small employer like Barnard pays health care based on recent usage, so I am contributing to future increases: apologies to my colleagues. For 36 years I barely saw a doctor, so maybe it averages out.

I am doing much better than I was on November and December. The breathing problems are essentially gone. The incisional hernia is annoying and causes some belly pain. I am deeply fatigued and have very little stamina. I am taking daily walks again, hoping that will improve. But I am also trying to figure out how to feel and act less like an invalid. I have had a lot of visitors recently (thanks), and am getting out to see people quite a bit. Officially, I begin a year-long sabbatical this month. A year ago I was contemplating how I would use the sabbatical to devise a role I might play after retirement. I was thinking about how I might get involved with influencing public policy on climate change. What should I do with my sabbatical now? I don’t know.

1 comment:

Sumner said...

Sally,
our experience is very similar. My wife had $125K in billed expenses over the past 6 months, of which Aetna paid $70K, and we paid about $2.5K. But, if I had no insurance, I'd be on the hook for all $125K.
Glad to hear that you're feeling a little better.
best,
sumner