Self-Pay Discount Offered by Hospital Patient Billing Department

A recent experience with the local hospital following a round of Rituxan treatment demonstrated that the local hospital has put in place patient-friendly policies.

During the conversation with patient billing, I learned that the $9,186 charge for a single Rituxan infusion had been reduced since the system had incorrectly designated my account as self-pay. The discount was a whooping 50 percent!!

If I were a patient who truly did not have health insurance, this would be great. To get a discount without having to ask or negotiate for it. How amazing is that?!

I’m glad that I do have insurance coverage and that the drug company will pick up my share of the cost for the drug portion of the treatment. But it's nice to know that my hospital has put policies in place that help patients obtain and pay for treatment. Check with you hospital to see if they offer similar discounts—it could make a real difference!

Read this post in its entirety:

Hospital Offers Self-Pay Discount to Patients

Maximizing Medical Dollars

Timing medical treatments to maximize dollars saved. As the year is quickly coming to a close, I wanted to confess one of my little medical secrets. I have postponed medical treatment based on health insurance coverage and out-of-pocket cost. I have also scheduled medical procedures near the end of the year because insurance would pick up the entire tab. I’m sure that I’m not the only one.

Read this post in its entirety:

Timing Medical Treatments for Financial Reasons

Insurance Woes

With my birthday coming up soon, it is once again time to learn what my health insurance premiums will be for the coming year.  My policy renews automatically each year and I have nothing to do but make sure that the premiums are ALWAYS paid on time.  As long as I stay paid-up, the insurance company cannot drop me as a customer although I've become expensive for them.

Since I am self-employed, I have an individual health insurance policy.  I obtained it 11 years ago when I shopped for the very best coverage available to me.  At the age of 32, my monthly premiums were $151 for a 'preferred provider' plan.  My copays are $25 for any doctor's visit; my coinsurance for covered services is only 10%; my deductible is a small $100; and my out-of-pocket maximum for medical care is $2500.  My prescription coverage is limited to $1500 each year, however.

Over the years, my insurance premiums have increased at varying percentages.  Last year the increase was 8.4% and this year it is 7.7%.  In 2009, the increase was 31%.  That was outrageous!!

So this coming year, my monthly premium will be $503.  That's a total of $6036 for the year.  I have to earn $9000 to cover that expense after taxes.

I was curious about what my same policy would cost a new customer, so I ran a simple search on my insurance company's website.  For a medically underwritten plan such as my own, a perfectly healthy person would be charge $516 monthly.  Just a tad bit more than I pay now.

My insurance company also offers HIPAA insurance plans for people who may be on a COBRA extension of group coverage and need to transition to an individual policy.  The HIPAA plans are much more expensive because they bypass medical underwriting and will cover patients with pre-existing conditions.  The HIPAA version of my same insurance plan carries monthly premiums of $1260.  

Can you imagine paying $15,210 each year for insurance coverage?!!  I can't.  This is the most expensive plan offered by my insurance company.

Looking at numbers like that just reinforces how important it is that I DO NOT LOSE my health insurance coverage no matter what.  It would be too risky to switch to something else.  I'm locked in for the long haul.

Maybe it helps to think of the $503 monthly check as not just current medical coverage, but insurance against having access to insurance for years to come.  At least that helps me feel somewhat better about the cost.

How about you?  What is your monthly health insurance premium and what does it cover?  What are your copays, coinsurance, deductibles, out-of-pocket maximums, and other coverage/restrictions?

Guide to Medical Services for Uninsured Patients

When you have any sort of health issue and are uninsured or underinsured, it can be challenging to know where to go for affordable health care. In this post, I hope to present a variety of resources which may be useful in obtaining necessary medical care.

Included are community health clinics and hospitals, public hospitals and academic institutions, Hill-Burton facilities, government programs, prescription assistance programs and the Patient Advocate Foundation.

Read this post in its entirety:

A Guide to Medical Services for the Uninsured

Ampyra (dalfampridine), walking ability and MS patients

Late Friday afternoon, January 22, 2010, the Food and Drug Administration (FDA) announced that they approved AMPYRA™ (dalfampridine, formerly known as fampridine-SR) as a treatment to improve walking in multiple sclerosis patients. Developed by Acorda Therapeutics in partnership with Elan Corp, AMPYRA™ is a proprietary slow-release formulation of the compounded drug 4-aminopyridine (4-AP).

Since I have no personal experience with either AMPYRA™ or 4-AP, I asked a couple of MS friends to share their stories. Please meet Connie and Melissa.

Connie’s Story:
Diagnosed with MS in 1999, Connie quickly learned that she has the primary progressive form of MS. Her initial symptoms include numbness in hands and feet, tingling in arms and legs, extreme fatigue and weakness. She was still walking unassisted in 2002 but by the end of 2005 needed hand controls for her vehicle and began using a walker, even after four courses of Novantrone.

Read this post in its entirety:

AMPYRA™ (dalfampridine) FDA-approved for MS patients; Connie and Melissa share their stories

Carnival of MS Bloggers #43

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

Yoga, Tysabri, and Insurance

For My Students: Yoga Invocation 
by Nadja

When I teach yoga I like to give freely of myself, to nurture my students and to help bring them closer to their true selves.

Nevertheless, I get as much out of my teaching as they do. Teaching yoga gives me a home, a place of sanity to stand when all I want to do is howl at the moon. It reminds me to breath. It reminds me of my favorite prayer by Saint Francis of Assisi:

"Lord make me an instrument of thy peace
Where there is hatred, let there be love
Where there there is injury, pardon
Where there is doubt, faith
Where there is despair, hope
Where there is darkness, light.
Oh divine master--
Grant that I might not so much seek to be consoled, as to console
To be understood, as to understand
To be loved, as to love
For it is in giving that we receive,
And it is in death to self
That we are born to eternal life."
Amen.

My heart is filled with gratitude for the things I receive from teaching yoga. I bow to my students. I bow to the teacher in all things. I prostrate myself to the divine with the faith that I will find a way no matter what.

Let yoga be your candle in the dark.
Let it lift you and fill you.
Let it in inspire you
Take what you discover on your mat into the world
And create peace, love and harmony.

Tysabri and Little Pieces of My Life
by Azoyizes

At my last neuro appointment, he and I had a talk about how my MS is getting worse and how he and I believe my current therapy (then), Betaseron, just wasn't helping. I told him that I wanted to start Tysabri infusions and he agreed.

Problem is, I have Medicare but no supplemental insurance. The Infusion Center figured that my co-pay would be $575 every four weeks. There is no way in hell that we can afford that kind of money, I don't care how good the drug works.

I contacted TOUCH, and they put me in touch with NORD. I got paperwork from NORD yesterday, and we'll get it filled out and make copies of our financial records, hoping that they will cover my co-pay.

If I do get to go on Tysabri infusions, it will be wonderful. I honestly believe that this drug can help me.

If I don't, I'm not going to get depressed or sad. I will just continue on with my life, deteriorating toward who knows what. I will be DMD-free, anyway.

In other news, I was invited to join a book club--my first ever. Our first book was Travels With Charlie by John Steinbeck. Loved it. We meet every other month at a nice little restaurant that is closed for lunch during the summer, except for the book club. We have great food, good discussions, and lots of laughter. Three of the women in the club (including me) have Saint Francis service dogs. The woman who started the club is also the woman who co-founded Saint Francis. There are 10 of us, and everyone is nice and friendly. Our next book (just started reading it today) is The Good Earth by Pearl Buck. Think I may have read it in high school, 40+ years ago!!

I have also volunteered and been accepted to be on the Outreach/Screening Committee for Saint Francis. Eventually, I will be calling people who have applied for a service dog, asking them questions and talking to them about the responsibilities and hard work that goes into training with your dog. I will sit in on interviews of people who have passed the screening, and I'll have imput into whether or not I believe they would be a good candidate for a dog.

These two things are giving me something to do outside of the house, and also giving me a sense of accomplishment.

Next Saturday is my 40th high school reunion. I am very excited about it. This is the first one I've ever attended. There are a group of us who have kept in touch through the years who are all going to sit at the same table. Next morning, this same group is meeting for lunch and talk. There are so far 45 graduates (plus spouses) who have signed up to come. My class had about 125 people in it, so that's not a bad turnout.

Getting Squeezed
by Lisa of Brass and Ivory

This week I received the annual note from Carefirst BCBS, my insurance company, informing me what my new health insurance premium rate will be for the upcoming 12 months. Of course, I expected that it would go up, no matter how I wished it wouldn't.

What I didn't expect was HOW MUCH it was going up!! 31% increase

OK, so it's not the first time the rate has gone up substantially -
In 2003, it was 22.2%. In 2004, 18.2%. In 2007, 19.9%. In 2008, 18.8%.
(see graph below)

But COME ON. Enough is enough. another 31%?

For insurance which doesn't pay for my MS medications, I will be paying $5172?

That's just for me, no one else, and is not subsidized by any employer since I am self-employed. And unlike most folks who have employer-sponsored health insurance, I will be paying Social Security, FICA, etc taxes on that $5172.

Why doesn't Carefirst cover my main MS medication, Copaxone?

• Because the drug benefit for individual policies is capped at $1500 annually.

How do I get Copaxone if insurance doesn't cover it?

• I have to qualify for assistance from NORD which administers the PAP.

How do I do that?

• I must earn less than 200% Federal Poverty Level (FPL) and can't have significant amounts of money in savings.

How much is 200% FPL?

• This year (2009), it is an Adjusted Gross Income (AGI) of $21,660.

For more on this story, see The Value of Money or Value of Health: What Do You See?

Now, to be fair, the $5172 in insurance premiums will not be 24% of my 'total income.'

Since I'm self-employed, I get to deduct the amount spent on health insurance premiums before income taxes are calculated. So it's a minimum of 19.3%, after Social Security/FICA tax is accounted for and before the AGI is calculated.

But, please tell me. Who can afford to spend 19-24% of the highest level of income they can afford (or are allowed) to earn for health insurance premiums?

And let's just say that for 2008 I did earn considerably less than 200%. In fact, $5172 really would be closer to, if not more than, 25% of total income.

According to proposed health care reform legislation, affordable premium rates for someone with my income level would be closer to 5% of income AND I would very likely have coverage for my medical needs, including pharmaceuticals.

A few weeks ago, I sat down and calculated what medical expenses were included during one year in obtaining the routine care I require. That detail can be read at Living with Multiple Sclerosis: The Cost of Chronic Illness.

Update: Now it looks like the Public Option just might get dropped during negotiations in Congress. sigh.


This concludes the 43rd edition of the Carnival.

The next Carnival of MS Bloggers will be hosted here on September 10, 2009. 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, September 8, 2009.

Thank you.

Comments for this post.

Getting Squeezed

This week I received the annual note from Carefirst BCBS, my insurance company, informing me what my new health insurance premium rate will be for the upcoming 12 months. Of course, I expected that it would go up, no matter how I wished it wouldn't.

What I didn't expect was HOW MUCH it was going up!! 31% increase

OK, so it's not the first time the rate has gone up substantially -
In 2003, it was 22.2%. In 2004, 18.2%. In 2007, 19.9%. In 2008, 18.8%.
(see graph below)

But COME ON. Enough is enough. another 31%?

For insurance which doesn't pay for my MS medications, I will be paying $5172?

That's just for me, no one else, and is not subsidized by any employer since I am self-employed. And unlike most folks who have employer-sponsored health insurance, I will be paying Social Security, FICA, etc taxes on that $5172.

Why doesn't Carefirst cover my main MS medication, Copaxone?

• Because the drug benefit for individual policies is capped at $1500 annually.

How do I get Copaxone if insurance doesn't cover it?

• I have to qualify for assistance from NORD which administers the PAP.

How do I do that?

• I must earn less than 200% Federal Poverty Level (FPL) and can't have significant amounts of money in savings.

How much is 200% FPL?

• This year (2009), it is an Adjusted Gross Income (AGI) of $21,660.

For more on this story, see The Value of Money or Value of Health: What Do You See?

Now, to be fair, the $5172 in insurance premiums will not be 24% of my 'total income.'

Since I'm self-employed, I get to deduct the amount spent on health insurance premiums before income taxes are calculated. So it's a minimum of 19.3%, after Social Security/FICA tax is accounted for and before the AGI is calculated.

But, please tell me. Who can afford to spend 19-24% of the highest level of income they can afford (or are allowed) to earn for health insurance premiums?

And let's just say that for 2008 I did earn considerably less than 200%. In fact, $5172 really would be closer to, if not more than, 25% of total income.

According to proposed health care reform legislation, affordable premium rates for someone with my income level would be closer to 5% of income AND I would very likely have coverage for my medical needs, including pharmaceuticals.

Update: Now it looks like the Public Opinion just might get dropped during negotiations in Congress. Sigh.