I've started the Normal Anatomy Countdown - we're at 13 days. I was at NAC:11 until I met with my surgeon today, when she requested I change to BWH's Faulkner location, which meant pushing it a couple days.
Today was pre-op appointment day. It started off with an x-ray of my colon. This is a weird thing. Maybe not as weird as the portacath but still up there. This was necessary to confirm the anastomosis from my last surgery (fun word meaning "communication between two tubular organs"). They use barium sulfate as a contrast. It's a relatively short, relatively uncomfortable procedure. I got to do it twice. After reviewing the images, they took another x-ray (sans contrast) and then she recognized that I had another anastomosis, the original one from when they took down the very first transverse loop ostomy, and she didn't get good enough images of that one. Just as I was about to get dressed and leave, she asked me if we could do it all over again. Better safe than sorry.
The second time around was slightly less unpleasant. I craned my neck so I could see the imaging monitor - you maybe don't want to do that if you don't want to know exactly how your insides look. It's pretty freaky. And mind-blowing. Imaging technology is unbelievable.
Then I met with my awesome surgeon who said everything looked just fine and we could proceed with the reversal. (I peeked at the images again on her monitor, too.) Such good news. The request to switch surgery days was unexpected but not a big deal. Also, at the Faulkner, apparently I will get a private room. I never thought that was a big deal until I didn't have one. It's a big deal, especially with GI recovery.
And then finally there was the appointment actually called pre-op, or "pre-operative screening." I just did that two months ago so wasn't sure what else they'd need. As it happened, since I had switched to the Faulkner only moments before, the BWH staff was no longer allowed to do the pre-op. But they didn't want to make me come in again so now I'm waiting for a phone screen to be scheduled with Faulkner staff. Or something like that. We were glad to be done early and grab a Penguin Pizza lunch.
And now I can start freaking out! Pre-op makes it so very real. And even though this time I don't need an epidural, and won't have a giant incision, and shouldn't have that much pain, and know what the outcome will be instead of not knowing until I wake up, and know that it's the outcome I want, it's still terrifying.
Thursday, April 27, 2017
Sunday, April 9, 2017
The Cost of Cancer, updated (hang on to your hats)
Recently I came to the realization that I only get estimate of benefit ("EOB") statements if Blue Cross believed I was responsible for a remaining balance. This explained a few things, such as why I had only seen charges for one round of chemo and seen nothing at all for radiation and seemed to be missing charges for one of my Neulasta injections. After inquiring with BCBS I received a summary of all claims from 7/26/15 through early March. It is jaw-dropping. I'll give you the numbers up front, followed by some thoughts:
Grand total: 876,358.46
Chemotherapy 112,638.30
Chemotherapy-related 146,856.91 (Neulasta)
Clinic/Consultation 18,676.55
Emergency Room 4,118.00
Inpatient 233,622.67
Labs/Scans 76,635.84
Medical Mileage 182.34
Medical Supplies 8,906.07
Radiation 119,350.62
Surgery 153,506.89
---------------------------------------------
TOTAL 874,494.19
then add in the updated out-of-pocket breakdown:
Clothing/supplies 261.86
Copays- appts 375.00
Copays- scrips 121.23
Food 360.18
Parking 746.00
---------------------------------------------
TOTAL OOP 1,864.27
First of all.. what?!?! Yes. Cancer is expense. Surgery is, too. I noticed that sometimes items aren't billed for nearly six months after the date of service. I'll ask for another summary towards the end of the summer, after my next & last surgery (May) and next scan (June). And I will keep doing that until I'm on a less frequent post-treatment scan schedule; I was told to expect one every six months for possibly three years, since my case was particularly nasty. I'll take bets on when the total hits a cool million.
I am fascinated by a number of things:
- Neulasta is no longer the most expensive thing on the list. The BCBS summary was not as categorical as the EOBs so I had to guess where to put some things. I think this is pretty close though. Staying in the hospital now looks like a big chunk of my overall treatment, given how critical that was when I was first diagnosed, and my desire to return to anatomic normalcy.
- BCBS only sends an EOB if I might owe something; it's almost like they don't want me to know how much things cost.
- BCBS sent the summary in a .pdf file. I'm a data head so I entered all the gory detail into the excel I've been maintaining. I think someone with lesser analytic curiosity and data entry skills would not have bothered. Again, it's almost like they don't want you know how much it all costs.
- Medical professionals and insurance companies make administrative mistakes. I do not know how they keep their records, but I think I found a couple of duplicate charges, and given how the information is presented (at least to me via this summary), those charges were paid each time. I wonder how many mistakes are out there and how much they contribute to inflated medical costs because we're reporting and analyzing the wrong data.
- I understand that before the ACA, there were lifetime caps on how much insurance would spend on you. I'm thinking I might have hit that cap. And I'm only 44. And have no family history of or genetic disposition for the disease I got. And am otherwise perfectly healthy. Sobering.
- The insurance "discount" given for everything makes no sense at all. If a service provider is okay with not getting paid what they say a service costs, why do they bother charging that price at all? So that people without insurance have to cough up the full, arbitrary cost? And insurance companies don't?
- I think I hate insurance companies, despite the fact that without my insurance I'd probably be dead. Or at least destitute.
- Say it with me: SINGLE PAYER.
I'm just flabbergasted. Once upon a time when I worked as a fund accountant at Investors Bank & Trust, I worked on a fund with around ~$10 billion in assets. For whatever reason this amount didn't phase me. One day the amount of cash assets hit $1 billion, just for that one day. For whatever reason, because it represented cash -- like money in my pocket, and not some bizarro mythological representation of a (sometimes made-up) financial instrument's worth -- that number phased me. I could not imagine such a vast sum of money. Inconceivable.
Now that I'm sort of grown up and have a mortgage, I can mostly digest the cost of my cancer treatment, even though it's much, much more than my mortgage. What I can't digest is that there are people without insurance, because a majority of politicians running our country don't believe that taking care of our citizens' health is a right, and that those lacking insurance will live if they are immensely wealthy or die if they are not. Inconceivable. Sadly, in this case, it means what I think it means.
Grand total: 876,358.46
Chemotherapy 112,638.30
Chemotherapy-related 146,856.91 (Neulasta)
Clinic/Consultation 18,676.55
Emergency Room 4,118.00
Inpatient 233,622.67
Labs/Scans 76,635.84
Medical Mileage 182.34
Medical Supplies 8,906.07
Radiation 119,350.62
Surgery 153,506.89
---------------------------------------------
TOTAL 874,494.19
then add in the updated out-of-pocket breakdown:
Clothing/supplies 261.86
Copays- appts 375.00
Copays- scrips 121.23
Food 360.18
Parking 746.00
---------------------------------------------
TOTAL OOP 1,864.27
First of all.. what?!?! Yes. Cancer is expense. Surgery is, too. I noticed that sometimes items aren't billed for nearly six months after the date of service. I'll ask for another summary towards the end of the summer, after my next & last surgery (May) and next scan (June). And I will keep doing that until I'm on a less frequent post-treatment scan schedule; I was told to expect one every six months for possibly three years, since my case was particularly nasty. I'll take bets on when the total hits a cool million.
I am fascinated by a number of things:
- Neulasta is no longer the most expensive thing on the list. The BCBS summary was not as categorical as the EOBs so I had to guess where to put some things. I think this is pretty close though. Staying in the hospital now looks like a big chunk of my overall treatment, given how critical that was when I was first diagnosed, and my desire to return to anatomic normalcy.
- BCBS only sends an EOB if I might owe something; it's almost like they don't want me to know how much things cost.
- BCBS sent the summary in a .pdf file. I'm a data head so I entered all the gory detail into the excel I've been maintaining. I think someone with lesser analytic curiosity and data entry skills would not have bothered. Again, it's almost like they don't want you know how much it all costs.
- Medical professionals and insurance companies make administrative mistakes. I do not know how they keep their records, but I think I found a couple of duplicate charges, and given how the information is presented (at least to me via this summary), those charges were paid each time. I wonder how many mistakes are out there and how much they contribute to inflated medical costs because we're reporting and analyzing the wrong data.
- I understand that before the ACA, there were lifetime caps on how much insurance would spend on you. I'm thinking I might have hit that cap. And I'm only 44. And have no family history of or genetic disposition for the disease I got. And am otherwise perfectly healthy. Sobering.
- The insurance "discount" given for everything makes no sense at all. If a service provider is okay with not getting paid what they say a service costs, why do they bother charging that price at all? So that people without insurance have to cough up the full, arbitrary cost? And insurance companies don't?
- I think I hate insurance companies, despite the fact that without my insurance I'd probably be dead. Or at least destitute.
- Say it with me: SINGLE PAYER.
I'm just flabbergasted. Once upon a time when I worked as a fund accountant at Investors Bank & Trust, I worked on a fund with around ~$10 billion in assets. For whatever reason this amount didn't phase me. One day the amount of cash assets hit $1 billion, just for that one day. For whatever reason, because it represented cash -- like money in my pocket, and not some bizarro mythological representation of a (sometimes made-up) financial instrument's worth -- that number phased me. I could not imagine such a vast sum of money. Inconceivable.
Now that I'm sort of grown up and have a mortgage, I can mostly digest the cost of my cancer treatment, even though it's much, much more than my mortgage. What I can't digest is that there are people without insurance, because a majority of politicians running our country don't believe that taking care of our citizens' health is a right, and that those lacking insurance will live if they are immensely wealthy or die if they are not. Inconceivable. Sadly, in this case, it means what I think it means.
Saturday, April 1, 2017
Final Takedown
My (hopefully) last surgery is now scheduled: Monday, May 8th. This is ten weeks after the last surgery and two days after the Jimmy Fund FitFest. I'm still not allowed to lift anything so my performance at the FitFest may be less than stellar. That said, if I did it last year, just two weeks after debilitating radiation treatment, I will probably be okay. I'm speaking again too, did I mention? I need to update my speech.
I haven't freaked out in the same way I did after scheduling surgery number three. This last one is supposed to be much easier and quicker, and with less pain and fewer post-op hospital days, although still more than truly needed, as they wait for your GI function to wake up before they discharge you. Pre-op appointments are on 4/27, which also happens to be my daughter's 17th birthday. I will probably freak out then.
In other news, in looking to update the cost of my cancer, I realized that the medical supply vendor I use owes me a little bit of money, due to timing of my orders and when they receive the insurance payments. While researching the discrepancy I realized I only get an estimate of benefits statement from BCBS when there is a remaining balance due per that statement. I couldn't find the full list of claims via the BCBS member portal either. I contacted them and they are helpfully gathering every single claim between July of 2015 to date (all 251 of them) and will email me a summary of this information in the next 30 days.
I think this means that the $200K in costs that I had directly observed via these EOB statements is potentially a piddling amount. I think it means the actual costs are potentially significantly much much higher. This is not an April Fool's joke, either. This will be interesting.
I haven't freaked out in the same way I did after scheduling surgery number three. This last one is supposed to be much easier and quicker, and with less pain and fewer post-op hospital days, although still more than truly needed, as they wait for your GI function to wake up before they discharge you. Pre-op appointments are on 4/27, which also happens to be my daughter's 17th birthday. I will probably freak out then.
In other news, in looking to update the cost of my cancer, I realized that the medical supply vendor I use owes me a little bit of money, due to timing of my orders and when they receive the insurance payments. While researching the discrepancy I realized I only get an estimate of benefits statement from BCBS when there is a remaining balance due per that statement. I couldn't find the full list of claims via the BCBS member portal either. I contacted them and they are helpfully gathering every single claim between July of 2015 to date (all 251 of them) and will email me a summary of this information in the next 30 days.
I think this means that the $200K in costs that I had directly observed via these EOB statements is potentially a piddling amount. I think it means the actual costs are potentially significantly much much higher. This is not an April Fool's joke, either. This will be interesting.
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