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Questioning the Price
Costs of Care (Twitter: @CostsOfCare), where this post was originally published, is a Boston-based, non-profit organization that helps caregivers deflate medical bills and provide high value care. As part of the 2011 Costs of Care Essay Contest, more than 100 anecdotes were shared by patients and providers around the country that illustrate the role of cost-awareness in medicine. These stories will help expand the public discourse on the power clinicians have to curb costs.
The following anecdote is written by Court Nederveld, a patient from Florida who was among the winners of the 2011 Costs of Care Essay Contest.
Hypertension was the trigger that forced medical cost awareness to the forefront. My doctor decided that with my rise in blood pressure, it would be prudent to prescribe a blood pressure medication and order a nuclear stress test. With only a catastrophic insurance policy and a $5,000 deductible, it was imperative for my financial health to know the cost of both the drugs and the procedure up front.
The prescription was the first thing we faced. The script for Lotrel was written and a trip to the pharmacy revealed an out-of-pocket cost of $200 for a thirty-day supply. This was way beyond my means, especially factoring in that this drug would most likely be required indefinitely. Relating this information to the doctor resulted in a prescription for the generic Norvasc and the pharmacy cost was to be $138 for 30 days. Still beyond household finances. I then began to research Lotrel and Norvasc and discovered that they are combinations of two older – and cheaper – blood pressure medicines, amlodipine besylate and benazepril hydrochloride. I requested that my doctor write the script for these two separate drugs and I now take them daily at a cost of $7 for a thirty-day supply of both drugs.
Having successfully challenged the cost of prescriptions, my eyes were wide open as I began the quest for a nuclear stress test. My doctor, fully aware that I would be a self-pay, referred me to a colleague in our area. A phone call began with introductions, but then I quickly explained I would be a self-pay patient and needed to know the cost of the procedure beforehand. The doctor was unable to immediately provide a cost and, after checking with staff, requested $2,500. I reminded him that I was paying out of pocket. He replied that it could be done for $1,900.
I told the doctor that I wanted to be sure I understood. I asked, “If I walked in with a check for that amount, I would walk out with the test results?” The physician responded that I would need to come in for a consultation first. Cost $250. I asked again, “If I walked in with $2,150, would I walk out with the test results?” Again, the reply was that there would have to be a follow up visit to review the results. Cost $250. Hesitation must have been detected in my voice or the doctor detected a possible mark, because the doctor then said that perhaps I didn’t need a nuclear stress test and a regular stress test would suffice. Cost $800.
Consultation and follow up not included. I then asked what would occur if the regular stress test revealed nothing. His response was that we would do the nuclear stress test to be sure. The inverse was also true; if the regular stress test revealed any anomaly, a nuclear stress test would be ordered to provide further information. Total cost out of pocket would be $3,450.
Feeling much like a cow on a milking machine, I began to test the theory that medical procedures should be available as a commodity. Using the Internet to begin my search, the only specific criteria required was that the location of the facility performing the test be within a short drive from home. It took very little time to find and confirm a company that would provide a nuclear stress test sans consultation, and would willingly and promptly forward the results to my primary care physician. To verify that all was understood, I informed them that I would have a check for the exact amount they quoted and no further remuneration would be forthcoming. All was as stated and the procedure was done. Total cost was $938.11.
While these two episodes have been the only challenges faced so far, having related these stories to friends and family, they also have begun to challenge costs and procedures with very similar savings.
It will be several years before Medicare is available to me and until that time, I intend to challenge every prescription or procedure as to necessity and cost.
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