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There are a lot of reasons that people get hit with daunting medical bills. But here are two I hear frequently:
- #SurpriseBills: People are being charged the out-of-network rate to see doctors they thought were in their insurance network.
- People who are covered under a family plan have to reach a family deductible – instead of an individual deductible – before their insurance coverage kicks in.
Two bills moving through Sacramento are trying to address both of these situations. The bills passed the Assembly and are awaiting votes on the Senate floor. If they pass the Senate, they'll return to the Assembly for final votes on any amendments. All of this must occur before Sept. 11.
Consumer advocates say these bills are urgently needed. Anthony Wright, executive director of Health Access California, says they will protect people from unexpected out-of-pocket costs, which have the ability to destabilize a family's finances.
Courtesy of Lee Tomlinson
Lee Tomlinson was diagnosed with throat cancer three years ago. He's since launched the non-profit Center for More Compassionate Care, where he speaks to medical professionals about the importance of caring for patients' spiritual and emotional needs, as well as their physical ones.
When 66-year-old Lee Tomlinson of Westwood was diagnosed with Stage 3 throat cancer three years ago, he says he had one thing on his mind.
"All I cared about was fighting for my life," Tomlinson says. "Nothing else mattered at those moments."
But in hindsight, he says, there was something else he should have considered: The cost of his treatment.
"You wouldn't walk in and buy a car and have no idea what it costs," Tomlinson explains. "But nobody brought it up."
"We knew we had some insurance, but we didn't know the length, and breadth, we didn't even know what the full treatment was about … it's a massive amount of information."
High drug costs 'only getting worse'
In reality, doctors don't know exactly how much a drug will cost a particular patient.
But they do know this: The cost of cancer drugs is skyrocketing. Last year, all of the new cancer drugs approved by the FDA were priced above $120,000 per year of use.
kbrookes via Flickr Creative Commons
One patient's chemotherapy IV drips.
For several weeks, I've been working on a story about how patients navigate the high cost of cancer drugs. But before I finish that story, I want to take a step back and ask another question: Why are cancer drugs so expensive anyway?
How quickly have drug prices been rising?
In short: Prices have been rising really quickly.
The average price of new cancer drugs increased five- to 10-fold over 15 years, to more than $100,00 per year in 2012, according to a recent article in the journal Mayo Clinic Proceedings.
In 2014, all new cancer drugs approved by the FDA were priced above $120,000 per year of use.
How can drug prices rise this fast?
Dr. Vincent Rajkumar offers at least four reasons for why cancer drug prices have been increasing. He's a professor of medicine at the Mayo Clinic in Minnesota, and one of 118 cancer specialists who co-wrote the Mayo Clinic Proceedings article on the high cost of cancer drugs.
Daniel via Flickr Creative Commons
I've been combing through the data and something jumped out at me: While there's a wide variation in the bills that new parents paid, several of you paid very little for your labor and delivery.
Two moms I spoke with paid just $250 for their entire birth. That cost was written into their plan, so they knew what their bill would be before they ever got pregnant.
What's the secret, you ask? No, they're not giving birth in bargain basement hospitals. Rather, they get their health insurance through an HMO, a health maintenance organization. And setting a fixed price for childbirth is standard practice among HMOs.
HMO vs. PPO
I've only had insurance coverage through a Preferred Provider Organization, or PPO, so these relatively low bills surprised me. But they didn't surprise Gerald Kominski, director of the UCLA Center for Health Policy Research.
I'm getting a bit of a reputation around the KPCC office: More and more, co-workers are seeing me as the health reporter who does a lot of crazy sports and occasionally gets hurt.
In January, I fell and hit my head on a rock while hiking and rock climbing in Joshua Tree National Park. I was treated in the emergency department and urgent care for that injury. About a week ago, I broke a bone in my foot while attempting to do an AcroYoga move. This time, I went to urgent care and saw an orthopedist. On top of that, I regularly visit the chiropractor, and now an acupuncturist, to deal with the aches and pains associated with these high-intensity activities.
I have a health plan with a high deductible that I haven’t yet met. So I’ve paid for all of this medical care using the debit card associated with my health savings account, or HSA.