Monday, October 28, 2013

To visit or not to visit... co-pays that is the question

For anyone following the latest and greatest news from around the globe in the United States, recently the health care system has been in an overhaul of sorts to cover more people and care for more conditions. Several Americans have fallen "between the cracks" and left uninsured or in some cases uninsurable. Starting excellent jobs that offer benefits (sounds great on paper) until that all to familiar fine print. Pre-existing conditions.

To visit a primary care doctor under my plan I pay $20, that price goes to $30 to see my Neurologist. Oddly enough, when I go to the office, they ask for $20, then I receive a bill for the other $10... I always argue with them and tell them it costs $30 and the tell me they "contacted my insurance..." whatever! Anyway, since I am suppose to see my Neurologist ever 6 months (and have a prescription that now requires it - thanks federal government for making me to be the bad person) it is now a minimum of $60 a year, and another $40 a year to see my primary (That doctor wants to see me twice a year as well).
Doctor fees- With insurance- $100 (not getting sick and going in extra)- GOD ONLY KNOWS the costs without!

Multiple sclerosis is not cheap. It not only is a decease that hides itself like a chameleon often causing Dr.s to all but throw darts trying to come up with a diagnosis from the start, but once discovered treatment takes on a whole new life. There isn't just one symptom. So there isn't just one magic pill.
Unlike diabetics who are treated with a insulin or a pill, or people with high blood pressure (although many would argue most of these people have both and are give a variety of combined medication to thwart their decease), MS has several different areas that are treated in many different ways.

MS Treatment- Currently there are so many options on the market. This isn't your Mama's MS anymore! We are truly the blessed generation and I am fully aware of that! Even since my diagnosis when my options were 1)flu for the weekend, 2) flu every few days, or 3) needle every day and spin the wheel with reactions. Believe it or not I did go with option 3 at the time! I'm not good with the flu! But before long pills were making their way through the FDA studies, and I myself found my way into one of the final phases. Now having been on Gilenya for a number of years, I really am grateful to all that research. But cost... whew! Gilenya-WITH insurance $50 (Gilenya Go does offer their program, but can be tricky because of insurance company "reduced payment rules")- $4672.27 without!

Let's look at fatigue. I love the argument, if you are tired just sleep. If I slept every time I "felt" tired I wouldn't work. What's worse is I go back and forth from bouts of beyond tire to two three days of total insomnia. Nothing says "WHAT DO YOU WANT!" like a woman that hasn't slept for two-three days... So for fatigue... yep, take a pill for that!

Nuvigil- WITH insurance $50 (pending on your insurance you may qualify for a discount card which could allow you to pay as little as $5 a month- to help you stay awake- well at least long enough to finish this blog).- $476.68 without insurance

Leg/muscle spasms (AKA restless leg)- Now this is one of my favorites. Who doesn't love that "I want to run" feeling at 2:00 am? I mean everyone loves being tucked in their warm bed only to bust up wide awake and run in the cold air until their legs feel better. No? Yeah, me neither! So of course a conversation with my Doctor later and I tired a few things. And by a few things I mean TALK TO YOUR DOCTOR! When you hear the side effect warnings at the end of the those commercials about suicidal thoughts- there's a reason! It wasn't because they asked me, but maybe they should have. So make sure with ANY drug you tell your Doctor your feelings (or tell him your feelings regardless). I tell him I don't like the room I'm in because the colors aren't right, but then he knows I'm doing well. So I'm back... So for this wonderfully delightful issue I take Baclofen- With insurance $15. (pending on the amount WalMart and other places do allow discounts- I take too many pills a month to qualify). $24.65- Without insurance (may be cheaper with discount plan)

Now some will argue they absolutely are related others will say one has nothing to do with the other, but I suffer from migraines. And actually I had my neurologist in place because he was already treating me for them. Is there a connection? Maybe. But I do know that heading to the pharmacy hits the wallet! My Replax which is govern by my insurance NOT my Doctor is limited to 4 pills a month. So despite my Doctor telling me how I can take it, my insurance says I can only have 4 migraines a month that require "that" kind of treatment... the rest- well I can suffer I suppose... Relpax- with insurance $50 (discount card is available- but again certain insurance companies/groups will not allow you to use them). $129.61- without insurance

But don't worry! My Doctor doesn't leave me hanging. He is a very preventative type of Doctor. He has had be on Topamax long before people started talking about it. (I thought it was funny). And when they released the generic, I really smiled. Topirmate- $15- $17.05 without insurance

Speaking of preventative, when I first started seeing my Doctor one of the first things he suggested was to make sure I was taking a good multi-vitamin (seemed easy enough) and to add 5000 Iu of Vitamin D. (The Sun?) I laughed! I live in Florida! Really? Can't I just go stand outside for 15-20 minutes? He asked if I wear sunscreen. Well of course, I'm not stupid! He smiled, take the vitamins. So several years later (this was back in 2004), seems this Doctor really has my best health in mind.
Vitamins (always wait for sales) $30-40 total

So if you were keeping track, yes that is $215 a month in prescriptions and vitamins. GOD forbid I get sick! Speaking of sick... I (and with my husbands help) self diagnosed my sinus issues (that were causing me to get so incredibility ill) and with the help of another totally government controlled over the counter medication... 24 hour sudifed max... I can breath clearly now... the snot is gone! I do have to take it every day, but oh what a relief it is. It only comes in 10 day packets, you can only purchase one packet at a time (from what I understand it can be used to make other stuff- DON'T ASK ME- I am CLUELESS!) So I play by the rules and pay my $9.89- (plus tax- God Bless America). Breathing-$43.33 a month- OUCH!

$257.33 monthly survival combined with $100 dollars for the yearly doctor visit costs... and don't get me started when the words "MRI" come up and my deductible come into play!
$5320.26- without insurance and NO Doctor visits figured in...

So the question always arises when something doesn't seem quite right... to visit or wait? Do I save my money, and just track what's going on and hope it doesn't get worse? When do I know its "too late"? How do I make the most of my money, since going in sometimes feels like I was only there to "pay at the door"?  How can I leave and feel truly valued for more than my pocketbook?

The truth is- you can't! You can't have those answers! The relationship between you and your doctor needs to be strong enough that you KNOW the answers. You know the value of picking up the phone, and you Dr knows when to "talk to you" (I know seems foreign) verses when to see you. Often, just talking through some important factors can set you at easy. You forgot he/she told you that eating after ___ was no longer a good idea? Watch Gremlins! Or that drinking too much caffeine not only affects your ability to sleep, but does mess with those "running legs"... That "phone call" may be all that's needed, or it may be an indicator of some more underlining issues that should be addressed. What do you mean you haven't "FELT" your foot in over a month?

Conversations are a two way street, but make sure you are always starting the conversation, and for goodness sake, make sure you are both on the same road!