Jane (not her real name) is an 83-year-old woman with rheumatoid arthritis. She was doing well on a combination of methotrexate and a biologic, but at her last visit she was aghast over the price of her biologic treatments. She is one of those old-fashioned types that worry about her bills, even though the government is picking up the tab. After she told me that her out-of-pocket expense was zero, I reassured her that she (unlike the government) was doing well and closed the topic.
She came back 6 months later and reported occasional problems with her arthritis, but overall, she was still doing well. Her anxiety over the cost of her biologic prescription, however, was not improving. At this point she wanted me to review a stack of her explanations of Medicare benefits (EOMB). The cost of the drug was $6,092 in June 2012, $15,846 in July 2012, and $16,583 in August 2012. She asked if I had changed her biologic dose, but I had not. Six months earlier, her treatments had been about $15,000 each, so the $6,092 bill for June was unusually low. The July and August bills were in line with the previous costs, although the prices were creeping up.
My frustrated patient called the hospital to find out why the charges for her biologic therapy were so high and so variable, but she didn’t get any satisfaction from her inquiries. She was told that the billing for her treatments had been outsourced. When she asked for a phone number where she could find an answer to her questions, the number wasn’t available. She asked the hospital employees if they would be able to locate the phone number if they needed it to recover a lost paycheck. That seemed like a wonderful question, but the hospital employees didn’t appreciate her insightful line of inquiry.
The hospital couldn’t or wouldn’t answer my patient’s valid questions, and I couldn’t either. Her arthritis continued to do well, but her drug combination had an expensive price tag to match its effectiveness. I ordered some labs, reassured her that she was still doing well, and asked her to return to see me in another 6 months.
Our health care system is in a muddle. Everyone is spending other people’s money in a system that doesn’t seem to have any checks or balances. My patient deserved answers regarding the cost of her treatment, but she had run into a brick wall. In an effort to distract an anxious patient to whom I’m giving an injection, I sometimes quip, "This won’t hurt me a bit." Regarding health care costs, my old gag could be reworded to, "This won’t cost me a bit." I probably won’t be able to explain her EOMB when she returns in 6 months, but hey, it’s somebody else’s money.
Dr. Greenbaum is a rheumatologist who practices in Greenwood, Ind.