Hospital Billing and Insurance

The prompt for this next clinical reflection meeting at school was the following: To what extent are physicians' values and decisions responsible for the cost of health care, and what responsibility do we have to control costs? How cost-conscious have the physicians you have worked with been, and what rolled does financial stewardship have in the professional responsibilities of physicians? 

But like so many other things, I was still angry about dropping $175 at Walgreens the other day for 3 vials of lantus and two boxes of test strips, so I had trouble focusing:

I think it is fundamentally irresponsible to be a physician unaware of the costs of medicine and health care services. That being said, a lot of physicians don't want to worry themselves with the details. Have I ever worked with a physician who seemed to understand how much things cost for patients? Not really. No. But consider this: how many physicians actually have chronic illnesses? How many doctors are on a ton of prescriptions at any one time?

            The horrors of being a type 1 diabetic have also allowed me insight into how much money it costs to be sick. I have dozens of prescriptions, and they are all insanely expensive.

o   Insulins (a normal thing that most people produce… I pay $100/month for insulin, with insurance, with BCBS… I thought that was the good stuff!)

o   Test strips ($100 for 100 strips! Maybe this is why I don't test my blood sugar 5 times a day as recommended! I can hardly afford to!)

o   Anti-depressants (at $50 for 90, they are by far my cheapest prescription. I could literally afford to overdose on these guys!!!)

o   Needles ($50 for 40--don't worry, I reuse them).

            But I think the worst thing that these high prices do, besides making me constantly trying to get off of all my medications and reusing needles, is make me absolutely furious with all my healthcare providers. I saw a doctor once, for a check-up. I needed to establish a new PCP. Besides diabetes, I also have a ton of other, normal age related health problems. I got the bill later. It had been a nice visit. The doctor was nice. She talked with me for like 40 minutes. The bill was $530. Because I was a complicated patient. $530. My co-pay was only $115, but still.

            And I am rich. My family has always been really well off. As we should be. Did you know both of my parents are surgeons? But these prices are obscene. I'm barely getting my budget together with my healthcare costs; how can poorer patients do this?

            Quick answer: they don't and they can’t. And I hate physicians for not doing more to help their communities. As soon as I get an MD after my name I am going to badger politicians into reducing the cost of insulin. Because it will clear my conscious. And because I think it's the right thing to do. I'm often angry enough to firebomb pharmaceutical companies like Eli Lilly and Novartis, but for the sake of professionalism I will just simply annoy anyone who will listen to me. And after I'm a doctor, I figure somebody will listen because I will be a board certified physician. Entrusted to know these things. Entrusted to help people: and you can't help people if you're prescribing medications they can't afford.

            In my mind, making note of expenses and calling on lawmakers to change the pharmaceutical company is a lot easier than burning out because your diabetic patients keep coming to the ER in DKA. You know why they're always acidotic? They can't afford their insulin. But no! You argue, they're smoking cigarettes. Hell, some of them are doing heroin. Doing cocaine. If they kicked the habit they could afford their meds. Well guess what? Insulin is more expensive than cocaine. We live in a country where it is healthier for your paycheck to have a dope habit than to have the misfortune of illness. And that’s just diabetes. Forget how much chemo drugs cost.

How depressing.