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The rich stay healthy
While the sick stay poor

U2, God, Part II

Who, me?

When I first got health insurance in my early 20s, I didn’t think about it much. There were several plans to choose from and I picked the cheap one with a certain cartoon dog.

That’s the privilege of health.

While I was stashing new cards in my wallet once a year, systems were becoming infinitely more complex: my body, the health industry, the number of people for whom I was responsible.

In 2008 I was shocked to learn that each of my six chemotherapy sessions cost over $17,000. Each of my 20+ radiation therapies cost $500. Add in the remaining year of Herceptin infusions, a couple of hospital stays, a double mastectomy and the costs skyrocket.

Anyone who’s ever read one of those Explanation of Benefits (EOB) from an insurance company knows there is a little hocus pocus going on here. There’s the sticker price ($17,000 per treatment, for example) and then there’s the negotiated rate – what the doctor has agreed to accept from the insurance company. Then you have a contract with your insurance company – they pay part and you pay part.

I have forgotten the exact total, but I know my year of treatment exceeded half a million dollars in negotiated rate dollars. I had to pay about 10% of that. A significant chunk, no doubt, but I figured it out and came out a whole lot more humble about health insurance.

A couple of years went by without much incident and I got a little lazy again about keeping up with changes.

In last month I’ve gotten intimately reacquainted with the process. This time it’s my 16-year-old daughter who went through a diagnostic process for Celiac Disease (CD).

Good villi/Bad villi

First a few words about CD. Because current fad diets often include a gluten-free component, CD is widely misunderstood. It’s not an allergy or a sensitivity, it’s an auto-immune disorder that requires a genetic mutation, some (yet unknown) environmental trigger or triggers, and the ingestion of wheat, rye, or barley. If you have CD, eating gluten containing products causes a certain antibody to go nuts and attack the small intestine. The small intestine has little fingers (villi) that wave around and absorb nutrients. In CD, those villi become flat and stop doing their job, particularly in the top of the small intestine where iron and vitamin D are absorbed. There’s no cure for CD, no medicines to treat it. For most people, the elimination of wheat, rye, and barley will allow the small intestine to heal over the course of about a year. The risk of CD is long-term – without dietary compliance there are serious, even fatal consequences.

Ok, back to insurance.

There is a protocol for diagnosing CD. It starts with a couple of blood screening tests to check for the levels of those antibodies. If those tests indicate CD, you need an endoscopy and biopsy. Under anesthesia, they insert a long camera down the throat, through the stomach, and into the small intestine. The gastrointestinal doctor (GI) looks for the flattened villi and takes several small samples to send off to the lab to check for CD damage. If that comes back positive, you have a diagnosis and have to eliminate all gluten from your diet forever.

My daughter’s diagnostic cycle took about 4 weeks. Here’s a rundown of the medical expenses. Sticker prices.

Doc visit for blood test: $290
Lab Costs for blood test: $469.27
Appointment with Gastrointestinal Doctor at Children’s Hospital: $590.32
Outpatient Operating Room Services: $6,808.06
Charge for Doc who performed scope/biopsy: $1,592.28.
Lab costs for biopsy: Dunno – haven’t gotten the EOB yet.
Costs for follow-up with GI, more lab tests to check blood counts, and meeting with dietitian: Dunno – that was yesterday so we haven’t gotten the EOB yet.

Our current insurance is “consumer-driven healthcare.” We pay a certain deductible before the insurance kicks in. Some years we don’t even hit that deductible. This year we already have. Of that deductible, the company reimburses part and we can save for part pre-tax. Of course the amount you have pretax is determined the year before, before you know what the year will hold for your family health-wise. The rest you pay like any other bill.

Once you meet the deductible, the insurance kicks in, generally 80% of services are covered until you hit the out-of-pocket maximum. When you file your taxes, you can deduct any medical expenses that exceed 10% of your adjusted gross income.

Our particular plan automatically reimburses us for the portion of our deductible the company kicks in or we have saved until we run through all that money. I pay the doctors when the bills come in.

I hope you haven’t fallen asleep yet.

Here’s the thing — I’M NOT COMPLAINING.

In fact, I feel stupid lucky that we were able to figure out my girl has this relatively rare disease, that the damage can be reversed, that I have both the time and brain juice to advocate and keep track of the financials, that my family can afford the high price of health care (and gluten-free food – YOW$A).

Undoubtedly, a lot of moving parts had to work in harmony for us to get here.

There are people who don’t have the support, the resources, the access to information, access to a doctor, the confidence to pursue a rare-ish diagnosis, and the money to pay the bills. Is our response to them – Oh well, better luck next time??

They deserve good health just as much as my family does. These are the people who need our help.

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