Once more unto the breach of practically indecipherable medical claims data. I discovered yet another undisclosed cost today: prescriptions! This latest adventure is after the fold. To avoid keeping you in suspense, please attempt to digest the updated grand total from 7/25/15 - 7/18/17:
Grand total: 932,206.32
Chemotherapy 112,638.30
Chemotherapy-related 146,856.91 (Neulasta)
Clinic/Consultation 19,352.55
Emergency Room 4,118.00
Inpatient 259,689.98
Labs/Scans 86,508.84
Medical Mileage 222.12
Medical Supplies 9,238.12
Prescriptions 5,582.53
Radiation 119,350.62
Surgery 167,175.16
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TOTAL 930,733.13
then add in the updated out-of-pocket breakdown:
Clothing/supplies 293.75
Copays- appts 375.00*
Copays- scrips 170.70*
Food 385.44
Parking 794.00
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TOTAL OOP 2,018.89
*For these two line items, since full costs are in the non-OOP groupings, I realized I was
double-counting them in the grand total; they are still listed to identify
amounts I actually paid (vs. what insurance covered) but I have removed
them from the grand total.
So, about another ~$55K since my last update. This is almost all surgery/inpatient; there are a couple different imaging procedures in there as well. If you can have cancer without having any surgery that is clearly the way to go.
As for the continuing saga -- this time around I tried again to review my claims on the BCBS member portal, and again I was unable to -- the one link I could find to "view your claims here" redirected me to a page where I could review my benefits. I requested another claims listing from member services, again reported this bug, and this time the person responding indicated that my account was never fully activated and this is why I couldn't view my claims. (The first time I reported this hyperlink bug it was dismissed with a "if it's still a problem let us know and we'll pass it on to our web services team." I didn't follow through that time.) I got the new .pdf claims listing and also got my PIN reset and instructions to activate it, and lo and behold, a new option to "Review Claims" showed up in the "My Account" menu, and I could actually review them.
Viewing claims online was about the same experience as looking at them on the EOBs or the .pdf listings that member services provided. The online experience felt more complete as you could drill-down from summary info to the specific claim detail; still the same info, just a different presentation. I could not export in any format, though I could print what was on the page (read: still manual entry to analyze). And there was still a bug: after drilling down into a claim's detail and then going back to the listing (via an easily identifiable button to do so), I could not drill down into a second claim. Instead I was brought to an error page that just said "ERROR:" and nothing else. I had to hit the back button a dozen times to get to the original log in page, and when I logged in again (thinking the portal had logged me out) I was again brought to the error page. Closing the individual browser window did not resolve; I had to clear cache / delete cookies or close the browser entirely to be able to log in again and view a single claim's detail per login session. Less than convenient.
A major difference from paper however is the search & reporting capability. Online I could choose a category of service and review just those claims for a custom date range (rolling two years' worth is available). As it happens, there is a category just for "Pharmacy" and these costs were not included in the EOBs or the .pdf listings from member services, or the print-out the pharmacy gives you with your medication (I checked the one I picked up most recently).
So, how hard can insurance companies make this, exactly? Portals that are buggy and error out, costs that aren't even available in the usual ways... I have found two bugs in as many hours trying to get my own medical claims information. Who is going to spend even that much time? And for the big data efforts out there, all the research and reporting on this subject in the last decade -- where are we even getting information on costs for medical services and prescription drugs? The providers themselves? Medical organizations like hospitals? Insurance companies? Pharmaceutical companies? Patients??
Because NONE of these sources, by themselves, appears to be meaningful or accurate. I don't know how we can expect to find a way to provide affordable medical care for every single citizen of our country without the RIGHT DATA. As of this blog, I have posted about this topic eight times:
8/28/15: https://eemthomas.blogspot.com/2015/08/everyone-needs-health-insurance.html
10/25/15: https://eemthomas.blogspot.com/2015/10/the-cost-of-cancer_25.html
1/3/16: https://eemthomas.blogspot.com/2016/01/the-cost-of-cancer-updated.html
2/7/16: https://eemthomas.blogspot.com/2016/02/the-cost-of-cancer-updated.html
8/28/16: https://eemthomas.blogspot.com/2016/08/the-cost-of-cancer-updated.html
1/8/17: https://eemthomas.blogspot.com/2017/01/the-cost-of-cancer-updated-also.html
4/9/17: https://eemthomas.blogspot.com/2017/04/the-cost-of-cancer-updated-hang-on-to.html
I've probably spent, at least, a full 40 hours on these 8 posts, between data entry and analysis and hunting down claims data when I realized I had to and trying to write something coherent about it all. I did that just for me and just for fun. Who in their right mind is gonna spend that time? We are all of us woefully misinformed.
Say it with me: SINGLE PAYER. But before then, as Cosmo in Sneakers so succinctly put it, "It's all about the information." Seriously. If anyone knows of real heavy duty medical claims or expense data whacking going on out there, let me know. Possible I should be looking into a career change.
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