Making medical decisions based on cost

Throughout my career I have been fortunate enough to have good, company-sponsored health insurance and have been in relatively good health. I only thought a little about healthcare costs when I was self-employed and we were on a continuation plan (sort of like COBRA). While the costs were not cheap, if I recall correctly around $1100 a month about a decade ago, we had good coverage and could see whatever doctor we wanted. When I lost my job last year I kept coverage through a COBRA plan until my new employer’s plan started; they had a 60 day waiting period which is kind of brutal if you’re trying to maintain continuous coverage.

When I picked a plan I picked what I thought was an okay plan: they had HRA plans which basically gave you a few hundred dollars to reimburse costs. It wasn’t until I started looking at the cost of the ulcerative colitis medicine that I have been on for many years that the costs started to sink in; the medicine, Delzicol, was about $600 a month vs the $70 for a 3 month supply that I had previously. That adds up quickly. I was in the process of weaning myself off the medicine since I had been doing well for years so I didn’t think much of it at the time. In addition to the medicine costs, the plan had a very high deductible and the doctors couldn’t tell me how much a visit would be until I got the bill. It wasn’t a regular PPO or HMO plan with a fixed fee for a doctor’s visit and the cost sharing didn’t kick in until I hit the deductible; the bill from a doctor was whatever negotiated rate the doctor would accept.

In November when I decided to become self-employed again I went on a COBRA plan through my old employer. Now I had to pay the full cost of the mediocre plan which amounted to over $1500 a month. While expensive, it was a lot better than having no coverage at all and luckily I can afford this.

About 2 months ago due to an issue with a client I had a lot of stress. Stress typically causes my colitis to flare up and this time it was a doozie. I resisted seeing a doctor but needed help. I went to see a physician’s assistant (they can prescribe medications which is good) and while discussing my condition with her and treatment options I was using the CVS/Caremark app to see how much each medication would cost. I shouldn’t have to put a price on my health but high costs would increase my stress and lead to a vicious cycle. One drug was $1000 a month, another was $500 a month so we settled on another drug where the cost was just under $100 for a 2 week treatment. She also recommended a colonoscopy, but I declined that as I suspect that would have been several thousand dollars.

Unfortunately the first medicine didn’t work so we went with another drug. This one was going to cost close to $200, but it had to be done. However, I found an app called GoodRx that shows you prescription costs and has a drug discount card attached to it. Using this, I was able to reduce my cost by about $45. Yes, it would cost me more with insurance to get a prescription than without it. That didn’t work either, so as a last resort we went with a drug I didn’t want to take, but has been quite effective in the past; that prescription, with the discount card, was only $15. Luckily, it seems to have done the trick.

The good news for me is that we’re changing insurance plans to one with more upfront pricing and hopefully more cost effective coverage. I’m also not going to rely on medicine alone to treat my colitis; I am embarking on a complete diet change (look for a future post about that) as I feel that there are potentially other treatment options for my condition.

I do feel fortunate that I can afford health insurance and out of pocket healthcare costs. This episode gave me a bit of a scare and really highlighted for me what some people have to struggle with due to the high costs of healthcare in our country; people shouldn’t have to make healthcare decisions based on cost. Unless I misread something or my COBRA coverage was different than normal employees get, besides base cost, the insurance plan really had a lot to be desired.

4 Replies to “Making medical decisions based on cost”

  1. Great post Scott.

    I’m in the Medicare for all camp. I think basic health insurance should be something every American citizen who lives here and pays taxes should be afforded. This would cover a yearly physical, a dental cleaning and an eye exam. The basic stuff everyone should be doing to stay healthy. And, it should cover the basics of emergency services and hospitalization. Beyond that insurance companies offer supplemental plans that people can buy if they want more insurance (like many of us on Medicare buy now).

    Coupled with that, I also believe in national service. Doesn’t have to be military but everyone needs to put two years in (WPA, CCC, etc.) . In exchange, citizens get basic health insurance and some college tuition assistance.

    I’m not optimistic that our government will think this way during my lifetime or could manage such a plan effectively but I do think this is a direction we ought to go in.

    1. Hi Richard,

      I think that affordable, basic medical care should be part of our society. Unfortunately, too many people are concerned with making a huge profit that they don’t put people first. It is very short sighted to not have this as lack of basic care leads to larger, more costly problems later.

      While I’d hope that our government could move in that direction, the country is far too split to come together on something so basic.

  2. Insurance through my company gets more expensive each year and the benefits fewer. A high deductible plan makes me want to go to the doctor even less. Medication is my financial responsibility until I hit a very high deductible.

    Dr. prescribes an $800/mo medication with a coupon brings it down to $325. Sorry, I can’t do that. Give me the non-time release version for $17/mo no coupons. No wonder insurance is so expensive!

    And over regulation, a sense of entitlement, a letigious soceity, and fraud is ruining medical care for all.

    Love your blog posts! Keep it up!

    1. Hi Mark,

      You’re right that are a number of problems causing high medical costs for all. You forgot patents as a reason for high costs; while I’m not opposed to patents, drug companies play games with medications to keep them under patent. One medication that I was on had its patent run out and then it was discontinued so that a generic couldn’t be made. It was basically a slight of hand to formulate a new drug and get another patent.

      I’m not opposed to companies making a profit, but I’d like to see more companies consider the human factor of their decisions.

      Thanks for reading!

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