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Health care costs: A pain in the neck
When you're in pain and in need of treatment, it's hard to pay really close attention to your health care choices. Commentator Renee Lux describes how treating her stiff neck led to a huge hike in her insurance costs.
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One morning this May, I woke up with a stiff neck. I applied hot and cold therapy all day and took an Advil before bed. By the end of that week, I was unable to comfortably move my head and I was feeling numbness down my left arm to my fingertips. I saw my doctor within 24 hours of calling his office. After a brief exam, he was sure of my diagnosis, but he scheduled me for a CT-scan at the hospital the next day, “Just to be certain.”
A day after the CT-scan he diagnosed me with Radiculitus Cervicalgia -- inflammation leading to nerve root impingement. I was prescribed a 10-day regimen of prednisone. By the end of my prescription, the pain was gone and my total out of pocket expense was $55 in co-pays. The unintended result of this diagnosis will cost me $2,220 a year in increased health insurance premiums for the foreseeable future.
Stress and anxiety was likely the root cause of my radiculitus. Stress and anxiety brought on by my search for affordable private health insurance. My husband had been out of work for over a year and our COBRA, with the government’s Premium Assistance Rate (ARRA), was about to run out.
I contacted a health insurance broker and explained that I needed an affordable, high-deductible plan for a family of four with no preexisting conditions. We are all healthy, all average weight and height, non-smokers, none of us are on medication and we have no issues with cholesterol or allergies and no plans for more children.
The broker found us an affordable plan and sent over an application for underwriting which I carefully filled out. Within hours of emailing it back to her I received a frantic phone call. “You said you had no pre-existing conditions!” she bellowed down the line.
She explained that having had a CT-scan and prescription medication within 30-days of my application made me practically uninsurable. She was adamant that the CT-scan alone would trigger an automatic denial. The broker suggested a high-risk plan, which is very expensive. If I couldn’t afford it, I could apply for Connecticut’s High Risk Insurance Pool, but I would have to be un-insured for 6 months in order to qualify.
“High risk?” I thought meekly. I don’t have diabetes, cancer or HIV. I don’t even have high blood pressure. How can I be high risk when my diagnosis was resolved with $5 worth of prescription drugs?
Now I was frantic! I called my doctor. He was incredulous, insisting that my radiculitus was resolved. He offered to write a letter on my behalf. I contacted a friend of a friend, a medical underwriter in another state. All she would say was that my diagnosis within a month of my application throws up red flags for insurance companies.
I took a deep breath and started over with a new broker -- we talked over the phone. When I told him about my recent CT-scan I could hear him sucking in his cheeks. There was a long silence.
Finally, he suggested we apply to three insurance companies at once, in the hope that one would accept me. The underwriting process requires me to state if I have ever been declined health insurance. A denial by one company would trigger automatic denials by other insurance companies.
I filled out three applications and agreed to phone interviews with underwriters for two insurance companies.
Eventually, one company offered to cover my family, but denied coverage to me. One company offered us coverage with an exclusion: “This policy does not cover any loss incurred by Renee Lux resulting from any injury to, disease, or disorder of the cervical spinal column, including the vertebrae, intervertebral discs, surrounding ligaments and muscles, treatment or operation therefor and complications therefrom.”
The third and final insurance company approved my coverage with a premium increase to cover my medical condition, “Cervicalgia/Inflammation of the neck.”
Had I known what the repercussions of that doctor visit were, I would have asked my doctor if the CT-scan was absolutely necessary for my diagnosis. Perhaps even the prescription could have been replaced with a higher dose of over the counter anti-inflammatory. The long-term effect of my “pain in the neck” is an additional $189 a month for the foreseeable future.
Renee Lux's essay "An Expensive Pain In The Neck" was one of the winners of the 2011 Costs of Care Essay Contest.
This is what health care has become - a risky guessing game in which the consumer has little chance to win. But as DG noted in the other comment, consumers do need to pay attention. Those of us lucky enough to have insurance are safely cloaked behind a co-pay and have become lazy. But once you're uninsured, suddenly prices matter. It shouldn't be that way. We all need to be aware of costs and we should be questioning the need for expensive tests like CT scans and MRIs. Yes, they are sometimes medically necessary and you should have them, but there are also alternatives that can be explored.
I just went for my annual physical and I was shocked when I was told what an office visit costs at my health clinic. I have been going to the clinic for 16+ years, ever since I was a college student; they have a sliding scale. Once I got a job with health care insurance I wanted to "pay back" the generosity and because they really did have quality health care. In the intervening years they won a large grant and built a new building and expanded their offerings to minor mental health care and emergency dental.
I calculated that over the years I have been a client of theirs the cost of an office visit has jumped 565%. So I figured well, I have had pay increases too and I took my university student salary which was just above minimum wage and I currently make about what an incoming professor makes 60k/yr. I then figured out the percentage increase and it came roughly to about 300%. In order to achieve the same percentage increase I would need to earn about what an incoming university vice president would make and compare that to a student assistant.
Here's where it gets worse. My wife reminded me that just three years ago that same office visit was only $75. That is a 255% increase over three years! A generous estimate would mean that five years from now a generic 15-20 min office visit to a doctor will cost upwards of $3000.00. How bad does it have to get to get the government to resolve this issue?
An interesting lesson, not just about qualifying for health insurance, but about how we approach using our health insurance.
The most important point is in the author's last paragraph:
"Had I known what the repercussions of that doctor visit were, I would have asked my doctor if the CT-scan was absolutely necessary for my diagnosis. "
The repercussions of that visit are actually twofold: 1)the later difficulty of obtaining health insurance, and 2) the cost of the unnecessary CT scan that was paid for by her COBRA insurance.
I have to believe that if this patient was aware of test costs, or paying for some portion of those tests, she may have initially declined that CT-scan, which typically can cost thousands of dollars and uses powerful radiation, especially when the doctor said: "...he was sure of my diagnosis" without the scan.
Instead, "....he scheduled me for a CT-scan...“Just to be certain.”' A red flag should have gone up at this point. Clinics and hospitals have lots of expensive tests and capital equipment that need to be utilized to justify their existence.
We need to be responsible health care consumers. Getting appropriate testing is important, but awareness is key, both financially and medically. It's no different than taking your car into the dealer and taking control of what's done, or not done, to maintain your vehicle.
On a similar topic, here: http://guiribusiness.com/your-surgery-is-expensive-but-we-still-do-it-fo...
is an article about a pilot program in Spain that, despite the country's free health care, has started to send out "Informational Invoices" to surgical patients. The program is called FIJATE, meaning "Pay Attention" in Spanish. (NOTE: The link I've included does not show the entire article. It was originally published in "El Pais" on Dec 14, 2011. Perhaps you have better search engines to find the full article.)
Sincerely,
DG
Minnesota
