The Headache of Healthcare

A doctor reviews the cost (and headache) of healthcare with a client.
A doctor reviews the cost (and headache) of healthcare with a client.

Why even bother?

Those three little words have unfortunately become my personal mantra with every visit to a doctor. This is in part because of previous bad outcomes, but more importantly due to the lack of transparency (and related healthcare headaches) in my cost of care.

Since my teen years, I have suffered from chronic and debilitating migraines. Like many “silent” conditions that can monumentally disrupt your life at any given moment, the outside world doesn’t seem to grasp the magnitude. Most people don’t understand and can’t relate to what you’re experiencing. Many medical professionals are faced with complex cases and very little answers.

I’ve been there, tried that with almost every treatment option for my condition. My never-ending fight for relief, or at the very least, a battle for a break, is exhausting.

It’s a perpetual rollercoaster of emotions. From the highest of highs when you think a new medication is working or when a physician has a new approach to your care plan to the lowest of lows the medication stops working or when you haven’t left your dark house in three days because of the pain.

My personal favorite though, is when your insurance won’t cover the cost of care for a specific treatment option that could actually work because it’s considered “experimental.”

Rejection, in any form, is awful. It’s human nature to become guarded as a result. Those emotions leave deep scars. Cynicism consumes you and doubt starts to define you.

From cynical to certain

Over the years, the twist and turns of the “ride” has taken a toll. My optimism, enthusiasm, and hopefulness when someone says I “have to see” this specialist or that I “have to try” using that treatment has diminished.

A few months ago, I was told about a new expert in the field who specializes in my condition and that I had to see him. I am very fortunate to have a medical professional in my life who went out of his way to call in a favor to get me an appointment. While I wanted to oblige the kind favor that was done for me, I couldn’t help feeling doubtful. I was hesitant to go and resistant to what the outcome would be.

Imagine my utter shock when I left this appointment feeling more optimistic than ever.

I’ve been to countless doctors over the years and I feel like they all had the same spiel and the same approach. But not this neurologist. He was different. This appointment was different.

He really understood what I have been going through for the last 20 years and offered a lot of success stories from the treatment option he proposed.

I couldn’t believe it. I was confident that the solutions he offered would actually work. That I would receive much-needed relief. That there could maybe, just maybe, be a light at the end of this treacherous tunnel.

A new approach

I have read about the use of Botox for migraines before, but wasn’t quite convinced it would work for me. But during my appointment, my uncertainly transformed into clarity. He described the success this treatment had on people with the specific type of migraine I suffer from.

He referred me to an anesthesiologist who specializes in administering this for migraines. I quickly made, and attended, my consultation appointment. The appointment confirmed that this course of treatment would provide me with the best outcome compared to the previous failures I’ve experienced over the years.

I was excited and incredibly hopeful. And I was feeling the highest of highs.

Skepticism sets in

I work in the healthcare industry.

So, personal patient experiences aside, I know how things work. I ask a dozen questions about everything during my appointment, especially about the cost of care for a procedure.

When I scheduled my first procedure with the anesthesiologist, I was very inquisitive about the insurance side of this. I was assured that the office had a team of financial counselors that specialize in getting this covered by insurance. But no one could tell me anything specific about the cost of care at that moment. There was no system in place to run my insurance through in real-time that could generate an immediate estimate.

I was told I would get a call closer to the time of the procedure to give me those details. Although a little frustrated with this, my optimism was still very much in-tact, so I waited. And waited.

Now three days before the procedure, I still hadn’t gotten a call with the estimate I was promised. I proactively called to find out the status. The administrator plugged in all of my information while I waited, and waited, to get a quote.

More than a half-hour had past and she finally had an answer for me. My estimated cost after my insurance “coverage” was going to be $1,900. Not $1,900 total. $1,900 PER session.

This procedure has to be repeated every 12 weeks and it is going to take 3 sessions to tell if it will work.

Since my specific insurance plan has a $3,500 family deductible and a $6,000 family out of pocket max, I’m looking at over $4,000 in medical bills this year.

Just to see if this treatment will work.

And within seconds of hearing her estimate, there it was again. Those three little words. Why even bother?

Financial headache or actual headache?

I live in a dual income household, with no children. My husband and I both have successful careers, we save aggressively, and live within our means. We’re lucky to be where we are financially. We work hard to maintain the level of financial security we have worked so hard to achieve.

This medical procedure, while something I have been desperately searching for with my condition, isn’t life-saving. How can I justify taking a minimum $4,000 gamble on something that may not work for me?

I am too risk adverse. I’m too realistic. I’m sick of this same old story.

I decided to investigate Botox cosmetically, and found that that same amount of Botox administered at a cosmetic facility would be 1/3 of the cost. Of course, it would not be administered in the same way, and as such may not have the same results. It does make me wonder though. Why does the same medicine cost more when going through insurance than it does when going to a day spa?

Doctors are charged with doing so much these days. It’s nearly impossible for them to treat patients and look up the cost of the procedures they are recommending simultaneously. This leads to a lot of upset patients who cannot afford the treatment plans that are prescribed.

The industry must catch up

The Healthcare industry has to rapidly catch up with nearly every other industry when it comes to providing instantaneous estimates. Patients deserve to understand the cost associated with their care. There are many innovative tools available to solve this problem, but this industry is slow to adapt.

If my doctor were armed with that kind of knowledge during the actual appointment, it would have saved me a lot of time and mental anguish.

It would have saved me from getting my hopes up. And it would have saved me from yet another headache.

It would have saved me from sounding like a broken record.

Because what is really broken in this scenario is our healthcare system.

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