Tuesday, September 2, 2008

The Logic of Medical Insurance Pricing

I think you might remember back in early June when we switched medical insurance and my G shots, Neupogen, the $1700/week drug, was a problem to obtain. For a quick recap, the new insurance company wouldn't cover me just picking it up, conveniently, at the SCCA pharmacy; instead, since my insurance categorizes Neupogen as a "special injectable", it had to be mail ordered, at least five days in advance. Well, I didn't have five days; I needed it that evening.

Anyway, the clinic is set up so patients can get their G shots administered if insurance won't pay for you to do it at home, so I set up five appointments and slogged in every day for a week, and spent a minimum of 45 minutes and $2 on parking every day. Ian and I wondered how much the clinic was likely to charge for the service.

Well, I got a bill today, and here's what it says:

$672.68 for the drug and a nurse to inject it, every day, even though I could've done it myself, for about $320 from the SCCA pharmacy, although, granted, about $275 from the mail order place.

Of that amount, the insurance company paid $520.65, or close to twice as much as at their prescription broker, and $200 more than the SCCA pharmacy.

$94.18 was an "adjustment" for the preferred insurance company status.

I appear to owe $57.85. So with the parking, it basically cost me $60 per 45-minutes to get those shots that week, when I could've done it myself for free.

There is a relatively good chance that I won't, in fact, have to pay those fees, because we found out while I was in the hospital that last year's health insurance actually covers us through the end of September. I didn't call the clinic to let them know until about a week ago, though, so I'm pretty sure this particular bill was only sent to primary insurance. Yes, I'll be on the phone again tomorrow, getting things straightened out. Or what counts as "straightened out" in the tortuous, knotty way of medical finance.

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