Runaway costs are the cancer in the health care system

Julie Mack | By Julie Mack |
on March 13, 2010 at 12:02 AM, updated March 13, 2010 at 12:16 AM

In a health-care system that has definite winners and losers, I’m a cancer patient who is among the winners — a person with excellent insurance and access to top-quality medical care.

But as I was sorting through some medical bills last week, I quickly came across three examples of how dysfunctions in the current system affect even patients such as myself.

Julie Mack mugJulie Mack

Example No. 1: In early February, my white-blood-cell count was low enough that my doctor suggested I get a shot of medication that would boost my immune system.

It was a borderline call, he said, but getting the shot would be more convenient than getting a blood test between chemotherapy treatments. Sounded good to me, and I got the shot.

The cost?

The West Michigan Cancer Center billed the medication at $8,761 and my insurer, Aetna, paid $3,290.  Another $365 was charged to my rapidly diminishing health-saving account.

Incidentally, I had this injection twice in February, so double those numbers for the total cost.

My point?

Until I saw the bill on the Aetna Web site, nobody said anything to me about this being incredibly expensive medication and that $730 of the cost would be coming out of my pocket. It’s a classic example of how the medical industry provides great medical care while leaving any worry about the cost to the unsuspecting patient.

Example No. 2: The actual injection of the $8,700 medication was billed at $93, of which Aetna paid $69.75.

Are you kidding me?

The injection was administered by a nurse and took about as much time as getting a flu shot. What about it could possibly justify a $93 bill?

I was so outraged that I called the Cancer Center billing department and talked to a supervisor. Her response: The billing department doesn’t set the prices and the prices are set by an industry standard. So basically: Not my fault and everybody does it.


Example No. 3: The bill for the colonoscopy that discovered my colon cancer wasn’t processed until mid-February and I didn’t see it until last week. And what a shock: “Your responsibility: $2,471,” read the Aetna statement.

The bill was from the Borgess Medical Center outpatient clinic, where the procedure was performed. It was mistakenly processed as an out-of-network claim, and I’m told by both Aetna and Borgess that the mistake will be corrected.

But the erroneous bill underscores several ways in which patients can lose out. One is how easily billing mistakes can occur.

Another is that navigating the in-network/out-of-network system is complicated and holds huge potential costs for patients. A third issue is how arbitrary medical bills can be.

Will the federal legislation pending in Congress fully solve these problems? No.

But it would be a step forward in addressing such issues, which are all too common — even for fortunate patients like me.
