Timing Medical Treatment for Financial Reasons

  • Timing medical treatments to maximize dollars saved.  As the year is quickly coming to a close, I wanted to confess one of my little medical secrets.  I have postponed medical treatment based on health insurance coverage and out-of-pocket cost.  I have also scheduled medical procedures near the end of the year because insurance would pick up the entire tab.  I’m sure that I’m not the only one.

    My health insurance policy has a modest annual deductible ($100) and a reasonable out-of-pocket limit ($2500) for the year.  Copays for doctor visits are $25 regardless if I’m seeing my primary care doctor, my neurologist, my rheumatologist, or my favorite nurse practitioner.  My insurance will also pay 90% of the negotiated cost of covered procedures and tests, leaving my responsibility at 10%.  After I’ve paid $2500 for copays or coinsurance, my insurance coverage will pay 100% of all covered medical expenses.  That is my “major medical” coverage in a nutshell.

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    My prescription drug coverage is separate and not nearly as reasonable.  Until the appropriate portion of the Affordable Care Act is implemented, my insurance policy will continue to limit prescription drug coverage (those prescriptions filled at a pharmacy) to $1500 each year.  The cost for six medications I take, although they are generic, is $240/month.  One brand name drug I take occasionally costs $410 per 30 pills.  I use a program offered at RxOutreach.org to help maximize my drug dollars.

    However with Rituxan (which is a biologic drug administered by IV infusion), my health insurance policy covers the expense under major medical rather than prescription coverage.  As a result, I am responsible for paying 10% of the approved cost.  This amount was $2341 for my last round of treatment in March, of which $1970 was attributable to Rituxan.  The drug company pays my portion for the Rituxan cost alone which goes a long way to satisfying my out-of-pocket (OOP) maximum for the year.

    It is not good that my medical expenses have become so high that my OOP limit is satisfied in the middle of the year.  However, it is amazing to move into the stage that insurance will pay ALL medical costs without copay or coinsurance required.  Last year, I scheduled my first colonoscopy partly because of symptoms I was experiencing but also because insurance paid the entire tap.  This fall, I had a number of doctors’ visits, underwent several tests at a cardiology office, and didn’t have to worry so much about costs as insurance covered it all in full.  (BTW, my heart is very healthy.)

    So when I chose to delay my next round of Rituxan infusions until January in order to minimize my out-of-pocket expense again for next year, it made complete sense to me.  However, it didn’t make as much sense to my rheumatologist who chastised me for having not come in to see her when my RA was moving in and out of minor flares earlier in this fall.  At the time, I was waiting to see if my RA would get worse or resolve on its own.  Although insurance would have picked up the entire tab, it still seemed smarter to wait until January if at all possible.  Maybe I am crazy to think this way.

  • So what about you?  Have you ever postponed medical treatment for financial reasons?  Or have you scheduled your more expensive health care into one calendar year so that either insurance would cover it all or so that you could deduct the cost on your income tax filing?  If so, we’d love to hear your story.  Please share your thoughts in the comments section below.

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    As 2011 is coming to a close, I want to thank you for your continued support and participation on MyRACentral.  Hope everybody has a very happy and healthy New Year in 2012. 


    Lisa Emrich is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers.

Published On: December 27, 2011