Consumer Directed Health Plan. One of the biggest jokes in the health insurance industry is the illusion of control. We pretend that you, the consumer, can control your medical expenses. We created products that, by law, have high deductibles, no office visit copays, and no Rx card. We know that you will shop for the best deals in primary care doctors and cardiologists. We are counting on you to force the doctors to justify every blood test, CT scan, and procedure. You know that you are a great shopper. Here’s your chance to prove it.
Can you shop for a deal when they are wheeling you in to the hospital with a blocked artery? “Hold up Mr. EMT. I just got a text alert that Hillcrest is having a sale on bypasses this week.”
But of course, none of this is real. There is no way to know the real cost of medical services in advance. And who amongst us wants health care by the lowest bidder? Plus, do we know anyone who is prepared to say to his doctor, “Another surgery? Gosh I don’t think we should spend so much just to save my life.”
The client is in the early stages of his treatment for prostate cancer. He and his doctors discussed the various ways to remove his prostate, external beam radiation, and even radiation seeds that can be implanted. The patient chose external beam radiation. The doctors then suggested that he also have hormone therapy.
Hormone therapy almost appeared to be an afterthought. By taking pills or getting shots the patient would inhibit testosterone production, shrink the prostate, and slow the growth of cancer. What shot? Which pill? The patient was told that the nurse practitioner would tell him when they met.
The client had a shot and got a bill a few weeks later. Ready? The shot cost $34,228.50. Surprise. The Anthem Blue Cross negotiated price for the shot was $18,932.99. The client’s deductible was $5,500. He blew past that. The client maxed out his share and Anthem paid the rest.
I looked at the bill and the first question I had was, “Did they buy you dinner?” I mean for this price he should have received a gift card for The Cabin. Sadly, all he got was an off switch for his libido. My second question was, “Is this some new miracle drug?” No, he was given Lupron which has been in use for over 30 years. The good news that it was a double shot, good for 6 full months.
$34,228.50 for one shot. Who knew? That’s easy. Everyone but the patient.
We have no control. Remember our friend the next time you wonder why your insurance premiums are going through the roof. I wouldn’t have done anything differently. You would have been just as surprised as he was. This shot is just one more example of a broken system in search of a solution.