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Post by seeingcrimson on Mar 19, 2015 18:11:34 GMT -5
So, I am starting to have my first experiences with the new plan. A recent routine diagnostic blood analysis that my doctor orders a few times a year to monitor elevated cholesterol and thyroid function, both of which require prescriptions to control, resulted in a $70 bill. A recent eye exam for my diabetic child also came with a sizable bill to us. So, I expect that these somehow go toward my deductible and the charges are based on some rational formula but how does one really know. Each bill requires contact with the insurer to try to figure out what's going on with the charges, etc. A big time consuming pain. Finally, I recently chose not to go to the doctor at all for a recent diverticulitis attack for fear that they would order a diagnostic scan; something done at the hospital and something I KNOW would be expensive to me. So there is my first case of avoiding seeking care out of concern for the cost. This really stinks!
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Post by rolando on Mar 19, 2015 20:29:07 GMT -5
Sounds about right. Mission accomplished by Harvard's benefits committee. Harvard just saved a bunch of money at your health's expense. This is what its all about.
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Post by frankly on Mar 20, 2015 8:20:09 GMT -5
Really interesting to see this story, and sorry for your difficulties, seeingcrimson.
The details of this experience point to one of the most confusing (and potentially harmful) aspects of the new plan design: when is a trip to the doctor just an Office Visit (subject only to $20 copayment) and when is the care received classified as "advanced diagnostic" (subject to deductible and coinsurance)? I don't think this question has been answered clearly by University Benefits representatives, in written communications or meetings, and I've been paying really close attention. When the details of the new plan started emerging, I had hoped (naively?) that anything happening in a doctor's office would be covered as an Office Visit. I think I was (intentionally?) encouraged to think so by the University PR materials and their heavy emphasis on the application of higher cost-sharing to Advanced Diagnostics. The materials made it sound like an MRI or extensive blood work that required a special separate visit to a hospital or specialty clinic would count as Advanced Diagnostic, while routine blood tests, urine tests, etc. that happen in the course of an office visit would be covered by the $20 OV copayment. Now that the stories start to roll in, I think that assumption was thoroughly wrong. It's really troubling to see in this story that a blood test performed in the doctor's office and a child's eye exam would both trigger deductibles and coinsurance. But I guess that's the new reality, as rolando comments. There's a huge potential for confusion about this in billing offices, also. As a patient, I would have no idea how to identify a misapplication or misinterpretation of the rules in this framework...
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shouldering the cost
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Post by shouldering the cost on Mar 20, 2015 9:09:50 GMT -5
A few weeks ago my son (6.5) hurt himself at school - it wasn't bad enough that I would go pick him up, but by the time he got home he was in a lot more pain. After calling his pediatrician she advised that I could go to the ER or wait until morning - that the end result would be the same - a Dr check - an x-ray and then likely a visit with some sort of specialist. She also suggested that we give him Tylenol to ease his pain. Once he wasn't in as much pain I made the financial decision to wait until the morning because I know that Dr visits are less costly that a trip the ER. The fact that money even entered my mind in the midst of my family's health issues was difficult to swallow. In the end he broke his arm and it turns out that waiting the 12 hours before starting a treatment plan wasn't a bad plan. However that knowledge is only gained in hindsight. I know I would've slept better if I hadn't had to weight the financial choice of whether going to the ER was going to be "worth it."
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Post by Waiting on Mar 20, 2015 13:09:38 GMT -5
Our family's costs have been higher, for sure, under the new plan. My spouse has diabetes and has had a couple of doctors appointments and a couple of tests plus prescriptions. The doctor and prescriptions have been the same, but have paid for the tests, which is new, maybe $200 so far. I also had what has been a routine blood test for thyroid stuff, I got a statement that said the charge was $220, but it was discounted with the insurance to like $30, which is what I paid. I have to repeat it, so i'll have to pay again. Had the same issue as above - my son (12) got hurt and we were deciding between ER or doctor. Called the nurse, and decided to wait until the next day to go to the doctor, although I've actually done that before because I don't like the ER if I can possibly avoid it (also, it turned out to be nothing, so we were lucky there, just $20). I do have the flex account and that has a debit card with it. I personnally recommend the flex account, but everyone's different. I went to the benefits committee presentation and there was talk about a form of the old plan being brought back. However, I earn slightly above the $95 thousand level and carry family coverage, so I will have to see how my extra costs this year compares to whatever would be the monthly cost for a return to the old plan. I guess I'm still in a wait and see mode. But it's very interesting to read what others are experiencing.
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Post by rolando on Mar 21, 2015 11:35:03 GMT -5
Be careful when choosing to avoid the ER in favor of a DR office or urgent care visit. My son had to have stitches and so we went to urgent care. The office visit was $20 and I paid $85 for the stitches for a total of $105. So while it was only $5 more than going to the ER $100, if UC did anything beyond checking basic vitals and writing a prescription it is probably more financially favorable to walk out of UC and go to the ER especially if there is any xray/testing/MRIs involved. All those are coved under the $100 ER copay and you max out of pocket will be $100. IN UC your looking at $250 plus 10%. Just saying!
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cath
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Post by cath on Mar 23, 2015 12:57:24 GMT -5
My husband is going to eye doctor today for first time under new plan. my fingers are crossed that the costs are not too terrible. He uses safety glasses for work...
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mark
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Post by mark on Mar 23, 2015 15:57:40 GMT -5
I was diagnosed with a rare blood cancer last year - thank goodness I opted for a clinical trial which picked up close to 100K of potential medical costs. I have a cancer that is treatable but there is NO cure - the drugs are very expensive and I take 20 medications daily. I worked during all of my chemo treatment last year (I would work all day and then head off to chemo at 5 PM) with the exception for the period of my stem cell transplant and post transplant recover. Last year I was at MGH well over 50 times for treatment and testing.
I expect to max out all of my deductibles moving forward, unfortunately the flexible spending account maximum under the current federal law is only $2,200.00 annually. I will max out all my deductibles and most of the flexible spending account by the end of the month.
I only wished that the potential changes/costs were communicated well before the sign up dates for the plans so I could cut back (I don't know where) and try to set aside $4K into the bank. There are lots of hidden costs besides the cost of the health care - i.e therapy for my young children to deal with my cancer, my wife not working during my stem cell transplant and post transplant recover period, hiring people to help do things I could not physically due or limited due to my suppressed immunity, parking. etc. If my doctor knew of the things I did during my recover to keep my family going - he would kill me.
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Post by 17yearsatharvard on Mar 23, 2015 20:48:42 GMT -5
very sorry to hear about the very stressful situation you are in, Mark. I hope the trial goes well. The communication of the change has to be the very worst aspect of the whole situation -- not only are we suddenly experiencing a significant pay cut (if we are already unlucky enough to be ill) but also HR thinks we should be excited about it -- great news, you have more options! (all of them bad.)
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Post by WorriedSick on Mar 24, 2015 6:47:12 GMT -5
I have a chronic illness that I inject immunosuppressants for. I've already opted to not see a doctor for 2 infections this year due to the expense. It's only a matter of time until I get hospitalized with something very serious.
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Post by Heartsick on Mar 24, 2015 10:44:51 GMT -5
Dear Mark and Worriedsick...my heart goes out to you both. Easy for someone who is not directly involved to say, but please do all that you can to take care of yourselves. Health is more important than money. You both provide painful examples of the human effect of such changes when they are managed and implemented less than well. Perhaps the university could think about a staff health advocate who might help people who are effected in this way to navigate the system and deal with the financial impacts. I am not talking about some simple salary based financial assistance program here! So much for all of the studies that said the changes would not cause people to avoid seeking necessary care. Really sad.
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Post by 17yearsatharvard on Mar 24, 2015 19:49:05 GMT -5
Of course people are going to avoid seeking care. This is what the designers of the plan admit, or rather proudly claim, will be the result of the co-payments. The negative effects may be balanced by a degree of benefit ON AVERAGE in the studies that have been done so far (did everyone see this study? www.ibtimes.com/heart-patients-enjoy-higher-survival-rates-while-physicians-are-away-national-1848114), in that there is some evidence that there is a tendency to over-treat in the US system that leads to negative consequences for patients. This is no comfort for those of us who are receiving well-judged care and have only negative outcomes when we avoid our doctors -- we are the ones providing the balance for the folks who do better when their doctors are away. |
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Post by unwell on Mar 25, 2015 19:32:12 GMT -5
IT BEGINS!
I've had asthma since I was 6 years old. Every year since I've had to take a breathing test 1-2 times a year. I had my first test this year and for the first time EVER - I'm being charged for it. $180. I know I will reach the $1,500 mark but I suspect its going to hit faster than I had thought. Its just hard to believe that after 30 years of having this test covered I now have to pay.
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Post by Disheartened on Mar 26, 2015 17:41:08 GMT -5
Sorry Unwell. It really does feel rotten when these charges start to come in for the first time. For those of us who have been at HU for a while, and really committed ourselves to working ever harder and longer through the financial crisis and beyond, it sort of feels like a slap. I never much expected a pat on the back but wasn't expecting a kick in the butt either. So much for engagement.
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FrightenedForTheFuture
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Post by FrightenedForTheFuture on Apr 2, 2015 16:47:44 GMT -5
My mammogram came back with some highly suspicious results. I've been referred to a surgeon for a biopsy, but after some calling around to get an idea of what my costs might be out-of-pocket I've left a message for my PCP to see if it is possible to delay for a year or two as I cannot afford the cost.
I don't have any luxuries in my life as is. It's not like I could cut cable, or sell my car to pay for additional expense.
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