Jan 22, 2014

Healthcare Whoopsie and Near Miss on a $4476.20 Mistake

Benefits election at work recently, we selected our health insurance for 2014 and added dependents as needed.  In the past, I've gone with the Cadillac plan, which means a higher monthly premium, but low deductible and $45 out-of-pocket for prescription refills.

Since Pigtails and I are generally healthy and rarely visit the doctor (just jinxed it, my stomach will blow up tomorrow), it seemed prudent to step down to the less expensive Ford Pinto plan this year.  The cheapskate coverage offers a lower monthly premium, but a high $3,500 deductible.  It also utilizes a health savings account, which means the insurer chucks in $1,500 yearly that we can use towards doctor visits and medicine refills.

The Cadillac plan is the better deal if you visit the doctor frequently, have surgery on the docket or intend to squirt out a baby.  The Pinto plan is less expensive if you rarely get sick and shun the hospital.


I have an intestinal issue called ulcerative colitis (U.C.).  Recommend you do not Google those words, nor look at the accompanying photos unless you plan to skip supper.

Popping a pair of Lialda pills daily tames my tummy trouble and puts the lid on code reds.  I screwed up and didn't check the price of Lialda refills before signing up for the cheaper health plan.  Nearly pooped my pants when I logged into the drug site yesterday and saw this for a 3 month supply of pills:


That's $4,476.20 annually to treat my U.C.  And with a $3,500 deductible before insurance kicks in, this wasn't turning out to be less expensive than the Cadillac plan.  Plus the $1,500 the insurer tosses into the health savings account starts at $0.00 on January 1, then slowly increases each month.

Called the doctor today and casually brought up my four thousand dollar whoopsie.  Asked if there's another type of pill on the market that isn't on the same price structure as platinum.  His nurse called back an hour later and said balsalazide disodium should work.  She had to spell that one out, and I asked what she meant by "should work."  It's a generic pill, so costs less.  Downside is 9 pills a day vs. 2.  Tapped it into the drug calculator, a 3 month supply looks like this, a third the damage of Lialda:




I'll have to pay out of pocket this first refill since the health savings account hasn't filled yet.  It will slowly grow each month and cover the rest of the refills this year.

Moral of the story:

The cheaper Pinto plan can be thousands of bucks more expensive than the Cadillac, depending on what pills you're popping.  Lesson learned.  I should have done my homework on drug costs, and it's worth calling doc' to seek out a less expensive solution.

-Beard

20 comments:

  1. For years I used Desonide lotion to tame my sebhorreic dermatitis (facial eczema) . It wasn't great, but it was the only drug that worked. It also was SUPER expensive, which I found out after I lost my insurance coverage. By chance, I asked a pharmacist about the SAME medicine in a cream (still generic). About 1/10 the cost AND it works better. Unfortunately, the drug I took for MS is prohibitively expensive--and no avenue for discounts anywhere--so I just go without and keep my fingers crossed. The drug game is such a puzzle. I hope now that I can get insurance, drug therapy will be an option again.

    ReplyDelete
    Replies
    1. Part of the problem with high health costs is patients have no clue what prescriptions and medical services cost, nor do they care since insurance foots the bill and we only cover a small co-pay. Once the cloak comes off and we start to see what things actually cost, that's when we work with our doctor to find a less expensive solution. I think health care costs overall would come down if patients were aware of what things cost, and actively looked for a lower price. Medical providers would also then be forced to compete, which would bring down the costs.

      Delete
  2. I love your blog and come here most days looking for updates. I travel to the US a fair amount and love the county, but on this issue I have to say thank god i'm British and I don't have to deal with these sort of issues.

    Keep up the great work on the blog. I need some more US food posts of huge steaks or something :)

    ReplyDelete
    Replies
    1. For sure, American Angus beef > British kidney pie.

      How is the waiting list for medical procedures and ability to get answers quickly from your doctor there? I've heard mixed results on that front from folks living in Canada and U.K., so curious what your experience has been.

      Delete
    2. Never had to wait for a thing personally - I saw my Doctor the other day, called the surgery at 11am and saw her at 6pm. I walked in and walked out in 10 minutes without filling out a single form. That's got to be better. You guys get peddled a lot of myths by the news in the US, that is honestly just rubbish, Yes not all of the machines you find in hospitals will be the latest and greatest, but the NHS has always done my family proud. That includes my father who broke his neck in two places and walks today because of their amazing care. Again no forms filled out!

      Oh and Scottish Angus beef > American Angus beef

      Delete
    3. That's good to hear it's working well there for you. The clowns here can't even get a healthcare website up without jacking things up. We'll see how it plays out this year.

      Legend says beer fed Japanese Kobe beef makes the best steaks. I haven't tasted it so who knows. That made me hungry, snack time!

      Delete
  3. Anonymous1/23/2014

    Check with your health savings acct administrator. With my medical Flex Spending Acct at work, I can go in the hole, getting reimbursed before payroll withdrawals have put sufficient funds in. I don't know what would happen if you quit before paying the FSA back, but I've been with my current employer for 21 years, so slim chance.

    ReplyDelete
    Replies
    1. I'll check on this, thank you!

      Delete
  4. Anonymous1/23/2014

    I used to have the "Cadillac" plan. I only had that because I was about to have a baby and with a $0 deductible, it was a smart move. We also got REALLY lucky because my husband is a full time minister in a Southern Baptist Church and our local Baptist Hospital covers half of our medical bills if we go there (so when insurance paid at least half, we didn't owe a dime!). I paid next to nothing (except my $250 a month insurance payment) to have my baby. I was hesitant to switch to the cheapest plan because last year I had my baby and a massive lower intestine infection resulting in having to get a colonoscopy in my 20s(!), but I feel it's a smart move. We'll see at the end of the year if my gamble paid off...

    ReplyDelete
    Replies
    1. Colonoscopies are are real treat, aren't they? The pre-procedure gallon flush of GoLytely is of the devil and anything but going lightly.

      The cheaper insurance plans can be risky, they end up costing a lot more than Caddy plan if you heavily use your doctor. On the flip, they can save a few hundred bucks if family stays healthy and you don't have to buy pills that cost $4476.20.

      Be healthy and hope your gamble pays out!

      Delete
  5. I agree that drug pricing is crazy ... my migraine meds are a perfect example: currently, $10; last insurance, $60; without insurance, $240; and, in the UK (when I was there), GBP6!

    ReplyDelete
    Replies
    1. Was the UK ₤6 version Flintstones chewables?

      Delete
  6. One caveat: sometimes the generics are crappy (bad pun). Can you switch the plan back if the new medication isn't great?
    Also, do you know how much a broken arm costs...I don't like to be so bleak but a kid can be expensive.

    ReplyDelete
    Replies
    1. We'll find out if the cheaper stuff works, poopy pants.

      Delete
  7. Anonymous1/23/2014

    Ditto the above comment about generics not being as good or working the same way. My FSA also allows withdrawals even tho I don't have the full amount deposited (it would take 'til the end of the year for that to happen). AND, I know you're healthy now, BUT . . .you can imagine. Do the best you can for you and for 'Tails.

    ReplyDelete
    Replies
    1. Okay, thanks for the tip on generics not working.
      I'll pick up a sack of Depends tomorrow on the way to work.

      Delete
  8. One positive thing about the HSA plans is you can pay yourself back for the out of pocket expenses once you accrue the funds in your account. It's an adjustment initially but I think you'll be glad you switched in the long run. Prescription prices can be a shock. We had a brown trouser incident too but the balance in our account is building nicely.

    ReplyDelete
    Replies
    1. Agree, a bonus that any unspent balance in the HSA rolls over to the next year. Trouble for me is even the less expensive pills will eat up all of my $1,500. Will give this cheaper plan a try and see how it goes, crossing fingers my stomach doesn't blow.

      Delete
  9. Anonymous1/25/2014

    Time to figure out how to get off those pills. I am not sure you can call yourself generally healthy if you have UC and are dependent on those pills to keep the fire out, so to speak. I mean that sincerely, you are healthier than most the population. No doubt. But why not strive for healthiest. I am confident there are alternative solutions. Heal the gut, it's all the rage!

    ReplyDelete
    Replies
    1. The old pills ran out two weeks ago and the new ones haven't arrived yet. Feeling fine so far, hopefully the streak continues. Some health problems you can't solve without pills, unfortunately...

      Delete

Thanks for the note, check back for my response!