Sunday, July 12, 2009

Trick Question

(Every so often at Pond Parleys, we’ll vary the format just to keep it interesting. This week Toni addresses one specific point and invites comment.)

TRICK QUESTION:

Q. When is an anti-biotic tablet not an anti-biotic?
A. When it’s masquerading as gold bullion.


Recently I had occasion to take one of the kids to a dermatologist (typical teenage skin problems). We were prescribed two creams and a wash, which cost me a total of $140 and that was after the discount they give through my health insurance company. The fourth prescription was for a thirty-day course of anti-biotics. The doctor gave me a “coupon” which assured me that I would only have to pay $25. Anyone in the States should set their “scam” alarm to go off when coupons offer seemingly big deals. Live by the motto “If it sounds/looks too good to be true, it probably is”.

My regular pharmacist referred the prescription on to a big chain pharmacy saying that he never managed to “get these things to go through”, and didn’t want to land me with the full bill.

“Oh, how much would it be normally?” I asked, innocently.

“Seven hundred dollars” he said. Yes, you read that correctly. Not quite sure what the conversion rate is today, but that would be upwards of three hundred and fifty quid on any day.

Now I have heard of some expensive medications before, but give me a break. I asked the pharmacist why it was so different from any other anti-biotic on the market and he said it wasn’t, it was just new and therefore the manufacturers “incent” doctors to prescribe it. (Not naming any names for fear of lawsuits.)

When I presented the prescription and coupon to the big chain pharmacy, no one batted an eyelid. I expressed concern about the coupon actually working and was told that they take this sort of rebate coupon all the time.

“So who picks up the other $675” I enquired, not quite so innocently this time.

“Don’t worry about that, your insurance company will be billed”, was the breezy response.

Now, without rehashing the intricacies of the US Health Insurance system, this was not the answer I was looking for. First, it’s not a “rebate” or any other kind of bargain if the cost is just being passed along to the health insurers. Everyone knows that the health insurers don’t absorb this cost; they pass it straight back to us, the people needing coverage, in the form of extortionate monthly premiums and “out of pocket” expenses. It’s no wonder the cost of health insurance is sky-rocketing and out of reach for over 47 million people in this country.

Second, and more important to me, we have a high deductible (excess) which we haven’t yet reached, so anything that is submitted to my health insurance company comes straight back to me in the form of a bill. I am NOT paying $700 for acne treatment no matter how much I love my kids. I called my insurance company, and I was correct, they wouldn’t be covering the cost. I then called the anti-biotic manufacturer to ask about the whole thing (more from a “discovery” angle than actually finding a way to get the tablets, at this point). Lo, and behold, on hearing that I would be picking up the $700 bill, they told me to get the pharmacist to re-enter me into their system as a “cash-paying patient” and the manufacturer would pick up the balance. So I did, and I think I only had to pay the $25, but can you imagine if I hadn’t started asking questions? I’d be interested to know how many people have been caught this way, and also if indeed, $25 is all I end up paying. Once that cost is processed, it’s very difficult to straighten it out because you can’t exactly take medications back and the system isn't particularly customer friendly.

This is not a call to debate the merits of one health care system against the other. I don’t care whose health care system you think is the best – a $700 30-day course of anti-biotics is a sign of an industry that’s completely out of control and out of reach for too many people.

Don’t you think?

15 comments:

  1. We moan about the National Health system here and National Insurance contributions are not exactly cheap, but I am glad we do have this *free* health scheme but fear that it might collapse under the strain as so many people are getting something for nothing.

    I have heard that many people in USA cannot afford to be treated at all. very disturbing. There have been programmes here of people queuing for a mercy doctor.

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  2. Both systems aren't perfect but THAT IS RIDICULOUS. What a scam.

    I would be really surprised to see any major changes get through even under Obama, those drug companies are really in control.

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  3. My wife had to see a doctor while we were visiting the US last week. We had travel insurance but we would still have to pay out of pocket and then try to claim when we got home. I was holding my breath waiting for the bill, but it only came to $140 for the exam and $40 for the perscription. Still, it could have been $5,000 and there would have been nothing I could do about it.

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  4. Did you see the recent article about why the health care system in America is so expensive? This is one problem (the drug companies, not to mention the unscrupulous doctors who prescribe things that are shiny new after being courted by the drug companies instead of prescribing generics that have stood the test of time) but the other is doctors over-testing patients when they get a kickback from insurance for ordering the tests. Totally, utterly disgusting.

    As for teenage acne, sometimes food-related. My sister went off dairy and her skin went almost perfect overnight. It was her docs in China who filled her in on the "what are you eating" view of teenage acne, and lo-and-behold... she had tried the antibiotics (both ingested and rubbed on the face) to no avail.

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  5. I think you'll be hard pressed to find anyone of any political persuasion who if satisfied with the current state of US health care.

    "I have heard that many people in USA cannot afford to be treated at all. very disturbing."
    Kinda. People don't have insurance or enough insurance so they put off preventative care. But hospitals must treat emergency room patients, so that's where people end up. If they really are so poor they can't pay, they won't have to, thus increasing the amount anyone else will have to pay so the hospital can stay afloat. Many people discover just how little their insurance covers. People go bankrupt paying medical bills (though usually it's one step removed, ie person pays medical bills with credit card then later defaults on payments).

    The system is insane, was never properly designed at all (just one accident piggypacking on the one before it), and leads to outcomes worse than pretty much all the developed world while being more expensive. It's just wasted money and health coming out all sides.

    Don't get me wrong you can get some of the worlds finest care in the US, but you have to be in the right place and have gobs of money/awesome insurance (not unrelated phenomenon). There is treatment out there that is second to none. But if Americans can't afford it, what does it matter.

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  6. NFAH - interesting. I hate to give up the dairy, but it might be worth trying since the treatment so far seems to be having minimal effect. And believe me, the doctor is going to hear the entire story when we see him again next week.
    Elizabeth - I live within walking distance of a Children's hospital, and every time we have to go there we have to wait behind kids with snotty noses who should NOT be in an ER. I'm glad they have a place to go but it shouldn't be there, and I shouldn't be charged over $200 for having a split thumb looked at and cleaned. Not stitched or anything, just cleaned.
    Apparently though, of the 47 million uninsured in the USA, about 30 million are working but simply can't afford the insurance premiums, meaning that they aren't eligible for the free care.

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  7. If I may attempt to ask a provocative question in a neutral tone, does anyone know if the figure of 47 million uninsured includes illegal immigrants or whether they would be on top of that number?

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  8. The figure includes illegal immigrants. If you google '47 m uninsured' you can get the full details (illegal immigrant fig varies by source. Of the balance, 18% or so of uninsured earn $50K + a year and elect not to buy insurance, 19-24 yr olds have highest rate of no insurance, etc).

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  9. It always amazes me how illegal immigrants can walk into hospitals and get treated since I am always asked so many questions. You'd think they would run from there in case they were "found out" although I know that hospitals aren't interested in their status.
    I don't really mind 19-24 year olds not having insurance so much as they hardly ever get sick, but if you have a family, you'd think insurance would be a priority, especially if you know you're not going to get any help from the government.
    It'll be interesting to see what the government comes up with as a "solution".

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  10. Once again, Thank God For The (flawed) NHS! I am so pleased I live in a country with free health care, but that doesn't ease my anxiety about my aging American parents and their increasing ailments. Or my good friends in the States who are debating having children because of the cost of just giving birth in a hospital.

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  11. My mother used to manage interpreter services for a hospital in Boston, and they pretty much pointedly did not ask many immigrants if they had documentation to be in the US if it wasn't offered. They felt it was they're place to treat people and not to report them to immigration or worse scare people into not seeking treated at all.

    While probably the most compassionate way to go, it isn't a policy without consequences.

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  12. This is the woman who was once asked to pay $220 for ONE Lotrimin pill to clear up athletes foot!!

    I did not.

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  13. Post script - we went back to the doc's today and I told him all about the above escapade. He looked slightly sheepish and assured me he would warn other patients if he prescribed the same "anti-biotic". I fell better knowing that someone out there might not be trapped into shelling that much money out.

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  14. As a long time expat (30 years) living in London I have more reasons than most to be grateful to the NHS. A few years ago I had kidney failure followed by dialysis and then a transplant. When you are really ill and need to concentrate on your health you have enough to worry about without having to think about the workings of the healthcare funding system and your finances. I felt very fortunate to be covered by the UK system.

    Peter Bond

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  15. There was a statistic on the TV yesterday saying that a large percentage of personal bankruptcies in the US are due to health care costs. Oy.

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