Thursday, August 14, 2008

Carnival of MS Bloggers #17 - Insurance Edition

Welcome to the Carnival of MS Bloggers, a bi-weekly compendium of thoughts and experiences shared by those living with multiple sclerosis.

"Cash, Credit, or Co-Pay?"

Coming to us from a London adventure in the land of free health care, Nina who blogs at Planning the Unpredictable discusses Insurance.
Since going blind in May, my insurance has paid out the following:

  • $1,500 for the Eye doctor
  • $1,000 for the Neuro doctor
  • $2,500 for the MRI
  • $1,000 for the Neuro doctor
  • $500 for the Neuro doctor
  • $6,000 for three months of Copaxone
  • $4,500 for the Spinal MRI
  • $400 for the IV Steroids
  • $1,000 for the Neuro Doctor
  • $500 for the Neuro Doctor
Total: $12,900 Medical Care and $6000 Drug Coverage
Nina's Out-of-Pocket: $200
[ed. Seriously? These were the negotiated and paid rates?]
Without insurance, this might have happened:

  • Cash out my retirement
  • Declare bankruptcy (isn’t medical bills one of the main reasons people declare bankruptcy in the US?)
  • Try to qualify for a state run program which wouldn’t allow me to see a qualified doctor
  • Ignore it and not receive any care
  • Get diagnosed but unable to afford Copaxone
My life is NOT worth more than anyone else's, but since I have insurance I get treated like it is. I am insanely lucky. I was diagnosed in a week after going blind. I had no problems with insurance. Out of pocket, it has cost me less than 200 dollars. Again, INSANELY LUCKY.
For more discussion on the contrasting healthcare systems in the U.S. versus the U.K., read the rest of Nina's post.

Next up, Lisa of Brass and Ivory explains that  
Since the relapse this spring, I have finally received all the Explanation of Benefits related to the three doctor's visits, 5-day round of IV Solumedrol, and a trip through the MRI tube.
  • $710 Three Neuro Visits
  • $3825 Solumedrol Treatment
  • $6000 MRI Brain/Cervical
Total Billed: $10,535
  • $5285 Insurance Paid
  • $4550 PPO Discount
  • $700 Lisa (out-of-pocket)
Total Paid: $5,985

Who ever said MS was inexpensive? Nobody I know.

On a different note, Lisa tells us that she just received notice of yet another large rate increase for her insurance premiums.

The chart on the right shows that the greatest increases were seen in the following two-year time spans: 2002-2004 (44%) and 2006-2008 (36%).

As it stands, Lisa's policy now costs $3780 each year, still without coverage for dental, vision, or MS meds.

It's no wonder that individuals with special health considerations are getting married to gain access to insurance coverage or worse getting divorced.

Just read this NYT article.
Health Benefits Inspire Rush to Marry, or Divorce
Published: August 13, 2008
With health insurance out of reach for many, obtaining coverage is factoring into the decision for more couples.

With that, this concludes the 17th edition of the Carnival.

The next Carnival of MS Bloggers will be hosted here on August 28, 2008. Please remember to submit a post (via email) from your blog of which you are particularly proud, or which you simply want to share, by noon on Tuesday, August 26, 2008.

Thank you.
Comments for this post.


  1. Yeah, I'm pretty much fed up with health insurance. I have to count my blessings that I'm still on my husband's plan. My Betaseron doesn't have a copay ($2k/month covered in full), so this is the real reason I stay on it. Otherwise, it's nearly $800/month for the 2 of us to be covered, and we have no dental or vision coverage. I just got my disability coverage and saw how tricky Medicare part D (Rx plan) is. It's easier and a little less expensive to stay where we are than put me on part D. Who knew Medicare, which is generally for older Americans, would be so crummy in its Rx coverage? So my disability payments are almost all going to make up the cost of Bill's expensive, small company health insurance premiums. But paying $800/month is far better than forking over $2k a month, so I'll thank my lucky stars that we have any coverage.

    PS: England and Canada are looking pretty sweet right now, eh?

  2. I should have said that those were the original charges and not the negotiated rates. When I get home, i will try and figure that much out. I am glad I am not a doctor because Aetna does not refund much.

  3. Jen, honestly I can't even imagine trying to figure out the disability payments, social security, medicare A/B, and then medicare D on top of it. Just looking at my own stuff gives me the biggest headache and makes me want to bury my head.

    Nina, I thought that was probably the case, but I wasn't sure. It's kinda funny, before my MRI they checked to see what my insurance allowed so that they could collect my 10% coinsurance. But they still submitted charges higher than the allowed.

    If you did know, this is a bit of a hot-button topic for me. :p

  4. Even in Canada we have problems with insurance. We can see specialists after having been referred from our family doctor (if we have one) and waiting a long time. Then there's the wait for tests like MRIs, which can take months. Once that is done, then there's the matter of paying for drugs.
    Luckily with recent developments and lobbying, the DMDs are covered by the individual provinces. But we all know of other drugs not necessarily covered by the gov't or insurance companies, if you're even lucky enough to be working enough hours to get insurance through work or you buy your own plan.
    In Canada we do have universal health care, but it doesn't mean we can get what we want or need.

    I had wanted to write on this topic Lisa, but I know so little about it even in my home and native land, that I felt I couldn't really contribute to this one. And the US of A is quite different to Canada when it comes to this.


  5. Shauna---

    Yeah, I keep hearing mixed reviews about Canada's universal health coverage. Not sure what the solution is. Obama is talking about it being one of his biggest priorities here. Let's see if he gets in.

  6. Shauna, I'd love to hear what your personal experiences are with seeing the doctors, costs, who pays what...those kinds of things.

    I shudder each time I hear McCain or anyone else talk about encouraging more folks to participate in the Individual Insurance Market here. I'm part of it and it really kinda sucks, especially when it comes to medications.

    It wouldn't be so bad if McCain were wanting to fix the problems with the Individual Market. But there's an attitude of 'it'll work itself out." (Yes, maybe I've already made up my mind who I'm behind in the elections, and he doesn't currently have lots of gray hair.)

    I love it. We have a conversation going on here.

  7. I am so busy and I never have time to read my mails from insurance company.

    I will catch up my reading. :)

    Glad this is still going.

  8. Insurance. The Dr. who does the most for me usually I pay him $8.50, once I owed him TEN CENTS! I have partner's State Ins., Medicare (several letters) and when I go to appts. I just toss my cards on the counter. I have asked my Dr.s and both Ins. co. which is my primary---NOBODY KNOWS! LOL
    In 1990 my srgery was over $10,000.00; I ended up paying $15.88---I actually told my surgeon I felt sorry for him (the ins. denied most of his cost) and he just laughed and said, "Dear, don't worry about me." I have had Blue Cross, Blue Shield, Blue cross and shield, Aetna, Uniform, Medicare. I took the advice of a boss in my 20s and always bought as much ins. as I could, even when I hadn't seen a Dr, in...20 years. It is the COST---WHO pays it? I did get zonked a few times/deductibles, hospital stays are the worst. That boss died within months of his good advice.

  9. So far, I am lucky with my insurance coverage. My husband is retired from the military and THEY have damn good insurance coverage for active duty military. There were some changes to the insurance when he retired, but it is still a good insurance plan. When we had dependents, our premium was $410.00 a year, not that it is just the two of us, and it is $180.00 a year.

    I was worried when I was forced to pick up Medicare and it became my primary insurance. I have to pay $1176.00 a year for Medicare. When I look at what Medicare pay for my medical bills, I am surprised any doctors or hospitals accept Medicare. I did not have to pick up Medicare Part D, thank God. My secondary insurance pays for my prescriptions and pays the rest of what Medicare do not pay for in my medical bills. My secondary also cover what Medicare will not cover. My Co-pay for Copaxone is $9.00, for generics it is $3.00, and for non-formula brand names $22.00.

    I would be lying if I said I am not worry each time open enrollment comes up for my secondary insurance. For my medication, alone they pay out $18,000 a year.

    If the US does go to a Universal HealthCare system, they need to look into the insurance coverage that is provided to military personnel and their families.

  10. I've read through so many blogs posted here and am surprised that most of the conversations I've read so far are about medications and insurance. Has anyone here had results with changing their diets? I was diagnosed 3 years ago December and have completely changed my diet. Anyone?