Insurance bill

Tom asked that I not put in writing about the amount of our last bill. He said you never know who might come after us for the difference. I told him I would compromise. I'll compromise and wont tell the whole amount. But I have to say that Riley is alive and getting well. He acts fine. You would not know that he is a sick child to see him. I remind Tom that he has other people's blood and platelets coursing through his body making him look healthy. His cheeks have color. He has energy. Riley even said he has come up with a cure for teen age acne, a once a week injection of platelets.



The bill for the hospital stay came. The pharmacy charge alone was $50,000. The ATG is a young drug, still under patent restrictions. Ten years ago there was no medicinal treatment for Riley's condition. A new drug gets a 14 year protection. Around the end of that time the drug is adjusted with improvements to get another 14 years hopefully. Research is expensive and those costs need to be recouped. Knockoffs or generics start to make their appearance. Insurance companies demand their clients get the cheaper drug. It may not be as good, but its cheaper. Wouldn't it be nice to pick an insurance that allows you or your doctor to decide what brand you should take.



We stayed in the hospital 10 days. Riley was injected for 6 days with this horse serum, along with the shots of blood booster and cyclosporine. He was also treated with Benedryl for hives and antibiotics to prevent a cold. he received a special shot that prevent Pneumonia by drying out the lungs.



Due to his lack of white cells, pneumonia is still a concern and he may get that shot again. He would not show symptoms just a full blown case within hours of contracting a cold. This particular shot prevents moisture in the lungs.



It is amazing how these drugs are so targeted to the particular cell or system of the body. The cost to me seems so small compared to the life saving good they do. Again, I am grateful for insurance. I just think its sad that they are able to negotiate at the other end. The hospital will only see a fraction of what they charged, what their costs were to take care of Riley. Insurance and the hospital will settle for a fraction of the cost. Its an insiders club. We are lucky to be a part of it, or that whole bill would be our responsibility rather than just a small fraction.



I think about how much we pay in premiums, and how much the company pays the difference. When we were on Cobra it was just under $1000 a month for a a family of four. Kaiser offered us a private insurance for about the same amount. I want to be able to buy the insurance I want. I loved Kaiser when we had it. I liked the HMO I had when Riley was born. That HMO was tied to a particular hospital back then. I do like this insurance, but it would be nice to check out other options. If people bought private insurance, then the lack of job security would not be such an issue. Riley now has a pre existing condition, much like cancer. Does this make him un-insurable as an independent adult, for this condition, once he moves out? He wont be able to role out his insurance from his father's like he will his auto coverage.



It just makes me think about the possibilities and limitations our existing system has. I can see the argument for having insurance through your company. They make sure you are covered in case of accident at work. But workman's comp covers that. There is negotiating power in numbers, but insurance companies usually dictate the premium they will offer. You can join a credit union for $5 and be part of that negotiating pool. I just think that there are a lot of games being played, and we are lucky to be on the inside and not left out in the cold.



I have never understood why insurance has to be tied to work. They don't pay my house insurance or my car insurance. We should be able to go out and shop our own policy. Do you want preventative coverage? Do you like going to the doctor all the time? or are you more the type that waits until your sick and then goes in. Do you have your teeth cleaned every six months or do you only go in when you have a tooth ache. I would like to go in every couple months for cleanings and because of insurance I only go every six months. Why am I trained that way? I could just pay cash for a cleaning, but I don't because insurance has me trained to a six month schedule.



When we were without dental insurance a couple years ago, I did pay $50 cash and take the children and myself to the dentist. The dentist had no problem with the arraignment. I just had to remind him not to do the extras, no x-rays. I paid an extra $40 for fluoride for the boys. When we had insurance, he was billing around $160 for a visit. I am guessing insurance settled for less, but not as less as $50 in cash. Perhaps the dentist was taking pity on us, and making sure we had dental care, or perhaps cash is king. It removed all the paperwork of insurance. It was immediate, not three months out in paying. Like an empty hotel room when you negotiate down the price, they would rather cover costs than have any empty room. The market came into play the way it is supposed to.



It seems strange that insurance and the hospital will probably settle for less than 25%. When a family without insurance comes in, there is no negotiating power, no way out. The doctors will know there is no insurance and may hold off treatment until other arrangements are made. Had it been a case like Riley's, the child would be dead. Our doctor commented that we were a record speed case from diagnosis to treatment due to the response of our insurance company. Tom made a phone call and his work smoothed the way with the insurance. We received immediate care, no questions asked because we had good insurance and a good employer.

The insurance does have a ceiling though. So, this week we are going to look into an umbrella policy. I don't know if we will get it yet, but we would like to know how much it would be. A policy that kicks in only after our regular insurance is exhausted. My dad had one. He never used it, but it was there just in case. That is what insurance is, a "just in case" policy. No one plans on having an accident or getting sick. You can't help it when it happens. You are playing a game of chance if you don't have insurance.