30 May What Are The True Costs?
By Debra Xiangjun Hayes
Navigating the U.S. medical system can be harrowing, daunting and sometimes more challenging than the conditions that plague American systems, especially because the costs of care and healthcare quality vary widely. When further complicated by insurance coverage, its limitations and the changes therein, patients and their family members are often charged with seeking the best, cost-effective quality care, ways to cover the cost of such care when insurance either does not cover it, or insurance companies cannot connect the pieces of the disjointed healthcare system to deliver the necessary care in a timely manner and do so in ways that fits neatly within their provider network and reimbursement agreements. Needless to say, any or all of these occurrences merely add insult to injury for the health care consumer and his/her family members. Instantaneously overwhelmed with tasks such as numerous phone calls to pharmacies, the insurance company, the medical professional, and the quest for additional resources such as community services, community health centers, or teaching hospitals and clinics in quest of the answers, stress levels soar, as does the frustration. This has become abundantly clear throughout the last ten years, but never more evident than last year.
For example, my son, who suffers from severe acne and numerous drug allergies was prescribed Solodyn. However, the dermatologist failed to disclose the price. The monthly prescription was over $500.00. Even with insurance, it was $300.00. Our single-parent headed household could not afford it! When my son inquired about alternatives, the dermatologist did give him a prescription card that greatly reduced the cost. Even then, paying the copay for the visit, $35.00, plus the monthly insurance premium and the $85.00 monthly prescription cost led us to seek food pantry assistance once a month. After all, these expenses totaled nearly half as much as our rent! When the generic became available, the prescription cards for the Solodyn were no longer available. The Solodyn price remained the same, well beyond our financial means. The generic did not work as well. He was heartbroken but settled for any improvement, no matter how little.
For my senior citizen mother afflicted with acute sciatica, she did not learn her insurance would not cover the prescribed muscle relaxants and pain killers until she went to the pharmacy. Whereas, it previously divided prescriptions so people could afford them a little at a time, they refused to do so, as did other pharmacies. The physician could not prescribe an alternative. Since this was an acute condition, we all absorbed the cost and hoped the prescription would deliver relief. It didn’t. We did find her acupuncture through an integrative medicine school in the area at little cost, which did render relief. Yet, securing the MRI required considerable cost comparing and numerous phone calls. Costs varied from $500-$5,000! Only two physical therapy sessions were covered. The rest she had to cover herself! Therefore, we located a place she could get to easily, one with experienced physical therapists willing to teach “self-care” and work incrementally. Through the combination of care, she did recover but not without considerable stress, which most likely increased the recovery time and associative costs.
Even my uncle, who suffered a stroke last year, had difficulty obtaining physical therapy coverage from his insurance company. After three months of convalescent care, the insurance company did not want to locate a physical therapist that would travel to his somewhat rural area and pay for such care. Given that the greatest post-stroke recovery from strokes occurs within the first three and six month periods, this was critical! It was even more frustrating when we realized he secured such services in his town a year before for chronic back pain and the insurance covered that. Now, he could NOT drive to such care! After a month of calls doctors in the area, we finally located a physical therapist that would come to his home three times a week. While he made some progress during that time, he had needlessly regressed during the previous month during which he was discharged from convalescent center and had no therapy sessions. Therefore, one might ask, “What are the true costs?”
Debra Xiangjun Hayes was a contestant in the 2015 Costs of Care Essay Contest.