Ulcerative colitis is not a fun disease, and it can be very painful. Nobody will doubt that. But let’s face it, insurance, medical bills, and medicine are not fun either, especially when it comes to paying for all these bills. One thing that is for sure, after you have a few years under your belt as UC patient, you just might feel like an expert not only in the disease, but in dealing with and managing the costs that evolve as well.
As my family has been involved with health insurance as a business for over 35 years, I have been learning about it by default since I was born, or at least since I can remember.
Here are some things I know for sure:
1) in the United States, health insurance costs having been rising for years and years, no end in sight either
2) there are many different types of health insurance plans to choose from, it can be quite confusing, and if you are in the middle of horrible colitis symptoms, this is probably the last thing you want to worry about
3) Getting health insurance after you have been diagnosed with UC is unfortunately very difficult and expensive(unless you are part of a group plan with an employer)
My POS(Point of Service) Health Plan:
As I was previously very healthy prior to being diagnosed with UC, I never thought much of my health insurance. That part is normal. After going to doctors every week, and seeing the bills rolling in, I thought about insurance all the time. The numbers that started piling up blew me away.
In the year of my diagnosis and still to this day, I have health insurance with Blue Shield, which for all you from other countries outside the US, its a large insurance carrier. My particular plan does not limit me to going to any one particular GI doctor, or any particular internal medicine, GP doctor etc… Basically, I get to choose where I want to go, and that has been helpful. What’s the downside of being able to choose which doctors you want to go to… well, as you may have guessed, this type of insurance plan costs more than other health insurance plans. The additional costs to me was roughly $125/month. My employer paid the remainder. Had I not been working, the fees to me would have been about $225 per month.
Now, besides being able to choose my doctor, this plan has what is called a deductible, which is the amount I have to pay out of pocket each year. In my particular case, I had a $1800 deductible. Again, this means that the first $1800 of medical costs(colonoscopies, prescriptions, office visits etc, remicade infusions, etc…) I had to pay myself in addition to the monthly costs of the insurance. ANYTHING after the first $1800 the insurance company would pay.
Recap: My insurance plan required me to pay the monthly fee, and the first $1800 of medical expenses, afterwards the insurance company picked up the tab.
What is a major benefit of having insurance?
Negotiated rates. Negotiated insurance rates are contractual agreements that hospitals, physicians, blood labs, MRI centers, and other medical providers have with insurance companies. In basic terms, this means that doctors can’t just go charging whatever amount they want to for a surgery, office visit, drawing blood, etc… There are pre-determined dollar amounts that insurance companies negotiate so common people don’t have to do that stuff.
If you do not have insurance, you may find yourself being charged much higher amounts form doctors and other medical providers. That’s right, you will get the exact same service, but just the billed amount will be much(sometimes over 10x) higher than for the next person who does have insurance.
What are typical costs for a New Ulcerative Colitis Patient?
These are the rough numbers that I dealt with, and again these are based on my expenses living in California, USA:
Visit to Urgent Care: office visit, blood drawn etc… $255.00
Office Visit with Gastroenterologist prior to colonoscopy: $173.00
Follow up visit after colonoscopy: $ 173.00
Asacol Prescription: $270.00 1 month supply
Prednisone Prescription: $ 10.00 relatively cheap
Blood Drawn $ 50.00
Promethius blood test $180.00
At the end of the day, I racked up over $5,000 in medical bills in just over 3 months. BUT, since I only needed to pay the first $1800.00 which was my deductible, after paying that, I never paid another bill.
Of course, when the year starts over in the US, many people have to start over with their deductible. So, come January 1st 2009, I was back to paying the $1800 once again. And of course, I hit that number before the end of the month. As I was having $173.00 office visits nearly every week, and blood drawn weekly as well, sometimes more, the deductible was easy to blow past.
When it came time for the old Remicade infusions, which had a negotiated rate of $4,650/infusion, well, you can see how great it is to have health insurance. For sure, I can’t ever imagine having an infusion and having to fork out $4,650 for two hours of time in the hospital… Especially if it doesn’t work!
Before this posting ends, please realize that everyone has a unique situation, all stories are different. Health Insurance is not a one size fits all. But one thing is for sure, health insurance in some countries is very complicated and people are not taught the ins and outs of insurance in high school, so get help on this type of stuff. Ask your friends who might know alot about health insurance. It could end up saving you all kinds of money.
AND OF COURSE
If you want to do what I am doing, get on the UC diet and tell the medical bills goodbye. I love knowing that I have not paid a single cent in medical bills in 2010 and by the way that things are working with my ulcerative colitis, that looks to continue.
If you have any questions on this stuff, I would be happy to tell you more about my experiences and the costs of things that I went through. Feel free to email me at firstname.lastname@example.org Also, if you have some good advice or insider/first hand experience with health insurance and your UC, please make some comments below, others could benefit and that’s what its all about.