For those reading this blog who have been lucky enough not to have to deal with a lot of medical bills, here’s how it works. You go to the doctor; weeks or months pass (seriously, I”m amazed at how long it takes for some bills to arrive); the doctor bills your insurance company; the insurance company sends you a “statement of benefits” that outlines what they were billed and what you then owe; and then you get the bill from the doctor/practice/hospital.

This is supposed to increase the transparency to you, the consumer/patient, so that it’s clear what you’re being charged for and what your insurance is covering. An audit trail, if you will. In reality, even the bills that are clear often contain items that are completely incomprehensible to the average person.

Whenever political debates about health care come up, there are people who argue that health care costs are (in part) inflated because consumers don’t know, or, more importantly, care about the actual costs of their care, since insurance covers most of it. If something you want to buy (a car, a house, a frying pan) is too expensive, you look at other options. If you have insurance and the “real” costs of your health care are masked, then there’s no economic forces to make people shop around for cheaper services, or ask if there’s a less expensive treatment option.

While I think this is an interesting argument, and one that I don’t think is completely off base, it misses the fact that “buying” health care isn’t like buying a car or a frying pan. Trying to find out how much something costs in advance of your treatment is often difficult or even impossible.

Before I started my chemotherapy, I had two separate conversations about costs. The first was a comment that my oncologist made in my initial meeting. She told me that 5FU, one of the main drugs in my treatment plan, was not only very effective and well tested, but it was also cheap. She commented that with the cost of many drugs being so high, it was nice to have one that was low cost, highly used, and able to get the job done.

My second conversation was with a hospital employee that I was referred to when I asked the question, “how can I find out what the post-insurance, out of pocket costs of my treatment will be?” “You should talk to Doug,” I was told. He’s the one who knows all about insurance issues. Doug was a very friendly guy, but when I asked him about figuring out what the costs to me would be, he told me that that was an almost impossible question to answer, primarily because every patient is different, and who knows what tests my doctor might order or adjustments to my treatment plan she might make over the course of six months.

I’m sure I could have pushed him a little more: “okay… let’s say everything goes according to plan and nothing needs to be adjusted, how much would it be then?” But, I didn’t. Mostly I didn’t because I already knew the details of my health insurance plan, which told me that I had a $500 annual deductible, after which my insurance would cover 80% of costs while I was responsible for the other 20%, up to an annual maximum of $5,000. Once that annual maximum was reached, insurance would cover 100% of any charges.

This is all a big lead up to the fact that in the last 48 hours, I’ve received the insurance statement and hospital bill for my first chemotherapy treatment (from September 9th). And let me just say… holy fuck.

Interestingly, the 5FU does appear to be pretty cheap. It’s only $7.80 (that’s the amount billed to my insurance company, not the amount I have to pay). The leucovorin, drug #2 in my cocktail, is $271.50. The oxalyplatin, drug #3, is $12,322.85 (!). Total cost for the entire first treatment: $16,119.45. I’m supposed to get twelve treatments. That means the overall cost of my chemotherapy is going to be somewhere in the neighborhood of $195,000.

The part that feels really unfair is that the oxalyplatin is the “worst” of the three when it comes to side effects and how it makes you feel. And yet, it’s the most expensive line item on the bill. It’s adding insult to literal injury.

A few more interesting tidbits from the bill:

• There’s a $17 charge for “routine venipuncture”. That’s how much it costs to draw my blood for lab tests.
• There’s a series of line items that correspond to my infusion routine, basically one line item for each time a new drug is hooked up to the IV. These aren’t the costs of the drugs themselves – that’s covered on other line items – but the charges for switching out the drugs. Each time it’s about $300. I’m not denying that my nurse’s job is important, but $300 for each time a new bag gets hung onto the IV pole seems like a price schedule that’s a little out of whack.
• There are two line items that have a cost of $0.15. I realize that every penny counts, but really?

I recognize that the cost of drugs includes the time and resources that the pharmaceutical company put into research and development, and I realize that a line item may include offsets for other parts of my treatment, but it really looks strange when it’s all printed out and you’re trying to make sense of it.

Continuing to review the bills and see all of these costs listed out makes me very grateful that we have good health insurance coverage through my job. I completely understand how a big medical “event” like this can completely change people’s lives and drive people to bankruptcy. Thankfully, that’s not a risk for us. And, while I know that the Affordable Care Act isn’t perfect, going through all of this definitely reinforces my opinion that everyone should have health insurance, and I’m glad that there’s at least some effort by the government to move towards getting everyone covered.