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Another Medical Mystery

By Laura Kolaczkowski—December 17, 2015

We recognize the cause of multiple sclerosis is one huge mystery waiting to be solved, but there is another medical question that plagues us almost as much….

What will treating my MS Cost?

Those forms that we are asked to sign anytime we see someone on our medical team that declares we accept full responsibility for the cost of treatment become so routine it’s often easy to not even think about what we are agreeing to.

I’m currently having physical therapy and speech therapy for MS and find myself asking this question aloud and no one can give me an answer. Here’s my scenario:

I am in PT, recommended to continue twice a week until at least the third week of January. No problem – my insurance covers 60 PT visits per calendar year so it is a service they will help with.

For now, until the end of this calendar year, I have paid enough for my medical care, including some large ticket items such as MRIs, that I have contributed all I need to out of my own personal funds and the insurance company will pay 100% of my PT costs.

Come January 1, that will change as I begin a new plan year and I start over with the costs I must cover out of pocket before the insurance covers anything (I have to pay the first $1,000 deductible).

After I pay the first $1,000, I share the costs 75%/25% with my insurance company, with them paying the larger amount, and this continues until I have paid another $4,000 from my own money. Note: that $4,000 does not include my doctor copays or my prescription costs. Those charges never apply toward my insurance deductible and add much more to my annual medical cost.

Bottom line – I have paid $5,000 of my own funds for medical services in this calendar year, and from now until December 31, my insurer will pay for everything at 100%.

So as I scheduled my future appointments, the receptionist said their calendars were wide open in January and I could pick whatever days and times I wanted. I remarked that was odd, because I had initially waited 6 weeks to even been seen for evaluation because their calendar was booked full – no open appointments. But then it dawned on me – January 1 is a new insurance benefits year for almost all of us and many people may need to be recertified for therapy services. The question of what it will cost me to continue in therapy after January 1 is also of importance, so I asked what those charges might look like.

The place I go to for therapy is a wonderful Neuro-rehabilitation Center, and it is associated with a large hospital network. When I go there for PT, it is billed through the hospital, and they are unable to give me an answer as to what will this cost until AFTER I have had the PT sessions.

The answer was straight forward and sobering – we don’t know what it will cost because we don’t do the billing, and even if we did we still wouldn’t know until we had an idea of what services were provided because each thing the physical therapist does with you is coded individually and reimbursed from insurance at different rates.

Imagine this scenario – you need to get a new car so you go into the auto dealer’s showroom, sign for one, you are randomly assigned keys and you drive off. Six to eight weeks later you get a bill for that car and you are obligated to pay whatever the amount might be. That would be nuts !!! You might be billed for a Mercedes or a Yugo (do they still make those?) You need to know up front what that car will cost and the impact it might have on your budget so you can decide which one you might drive home.

So why can’t we know upfront what our medical costs might be? Or at least a close estimate? I’m not talking about unexpected emergency treatment but simply one hour, twice a week, with a physical therapist who is helping me to walk better.

Story Source: The above story is based on materials provided by MULTIPLESCLEROSIS.NET
Note: Materials may be edited for content and length

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