We may have to move back to New England for treatment, again

I wish Boston was closer

I can’t believe this. A little over one year on from the insane cross-country move we were forced into by Juniper’s health plan, we’re now facing having to do it again to get Vi’s treatment covered. They’re denying her treatment in the same way they were denying mine. Her condition at the moment is less acute than the situation I was in, so we have time, but obviously this is not something we want to be faced with repeating.

What a CT scan costs

In the last update I explained the absurd CT scan denial and insane amount of effort we and our doctors and their assistants had to go through to get that approved. We’ve received the EOB for that now, get this: They billed $1,782.00 for the CT scan, the health plan gets a $534.60 discount, leaving an amount of $1,247.40 they allow to be billed. Of that we must pay a 10% coinsurance ($124.74) and the plan pays the remainder of $1,122.66.

Speaking almost perfectly to our situation is this recent article comparing the costs of US CT scans to those in the Netherlands: A CT scan costs $1,100 in the US — and $140 in Holland.

We asked what the cash price would be if we wanted to bypass the 3 hours of my time, 2 hours of medical assistant time, the 1+ hours spent on the appeal between 2 of her doctors, and however many hours of time spent by agents and administrators at Juniper’s health plan.

That cash price? About $450.

If you’ve never had a CT scan before, it’s a surprisingly quick in-out thing. They’re actually pretty cheap to operate, as the overseas experience shows. The amount of overhead involved in denying CT scans and trying to get them approved is insane. This country’s healthcare industry and their lackeys like to push a talking point that if we give everybody here healthcare like any other western country, then there won’t be enough people to provide that care and you’ll suffer. But the experience we’ve had, as demonstrated by this one example among many, is that clearly if we free doctors and their assistants from dealing with the insane administration overhead they’ll have much more time to spend on actual medical matters.

At $450 for a cash price, we are actually paying a real coinsurance of about 25% of the fair price, not 10%. And the health plan would need to catch two out of every three CT scans as being somehow fraudulent before it was better off being inserted into the decision making process, slowing everything down, and consuming all that time and energy. And that’s before we look at the opportunity cost with all that time that can’t be used to actually help people instead. There simply isn’t that kind of fraud anywhere in the system. And there simply is no way that some agent at eviCore is in a better position to know the medical need of a simple CT scan than the referring doctor and the radiologist administering it. This system is a giant scam designed to soak as much money out of the economy as it can possibly get away with.

Back to New England

We still are on the wait list to see some specialists for Vi. She clearly has an autoimmune small fiber polyneuropathy, the same thing Juniper’s health plan was denying treatment for in my case last year. That is what they are now denying her treatment for.

We’re also increasingly convinced she has Myasthenia Gravis (MG) and Neuromyotonia (NMT). Both are rare illnesses. NMT is exceptionally rare at apparently only 200 cases according to the internet. I think there’s an under reporting thing going on here. Talking to other people in support groups who also have it there has to be well more than 200 cases. (Maybe that number is case reports as opposed to actual prevalence rate.) Finding doctors who have the experience to properly diagnose this though is what’s taking a while.

Meanwhile the appropriate treatment for the autoimmune small fiber polyneuropathy is IVIG. We want her on that treatment while we wait to see the appropriate specialists for the MG and NMT. She may require thoracic surgery to remove her thymus, which can resolve the MG/NMT in about 30-35% of cases without further treatment. If not there are other treatments for the MG/NMT she may need to be on, but immune-modulation with IVIG is also one for those.

We will have to rename this blog How is Kris and Vi. More updates on the disability insurance situation after the break.