The hidden costs of chronic illness and disability

People with chronic or persistent health conditions, which affect six in ten in the US Centers for Disease Control and Prevention– May appear healthy at first glance. Most chronic illnesses are invisible to the average observer.

But the healthcare costs associated with these conditions are no joke. These costs are often invisible to patients as well. That is, until the bill hits and you face hundreds of dollars in surprise fees for a blood test or a specialist outside of your insurance network.

Perhaps you have just been diagnosed with a chronic condition, or you are a long-time patient working to manage your medical expenses. Below are some key fees to watch out for, as well as some ways to save – including choosing an insurance plan that works best for you.

drug

Do you have a chronic illness? You will likely fill out several prescriptions. How much you pay depends in part on your insurance coverage, if you have it. Health insurance plans have different “tiers” or classes for drugs, from Tier 1 (cheapest) to Tier 4 (most expensive). This can explain confusing cost differences for two similar-sounding drugs.

Some plans charge two separate deductibles – the amount you pay before your insurance starts – for prescriptions and doctor visits. The state you live in also matters, as drug coverage benefits can vary from state to state.

If a drug or treatment is new on the market, or if it is “off-label” or not yet approved for your diagnosis, it may not be covered by insurance plans. And when care providers combine or change medications to treat your specific condition, a process called “compounding” medications, plans will be reluctant to cover the medication since compounding is not approved by the FDA.

However, some of the biggest price increases are due to specialty drugs, which are often the same ones designed for chronic diseases.

Insulin, an essential medicine for people with diabetes, is a prime example. A study by the Health Care Cost Institute found the price of insulin almost doubled in four years from 2012-16. Every brand of insulin got more expensive. Insulin alone accounted for 47% (almost half!) Of the total annual health care bill for the average diabetic patient.

Saving on medication

There are a few tricks you can use to save money on prescriptions. Many drugs come in a generic version that works just like that as a branded version at a much cheaper price. Check with your provider or pharmacist if a generic can replace the brand names you have prescribed.

Newer drugs on the market are not yet available in generic form. Maybe you can participate in a clinical trial for a brand new medicine (under your under medical supervision of course) and receive the product free of charge.

Even pharmaceutical companies are waking up to the inaccessibility of drugs Prices. Resources like that Medical support tool (MAT) help patients find inexpensive options. The MAT contains a Directory of Companies that advocate price transparency and a list of their recipes.

You can also contact the drug company that makes the drug directly and see if there is a patient assistance program in place.four major insulin manufacturers do.

Trade visits

While insurance plans cover visits to general practitioners, the plans are lesser likely for visits to specialists – doctors with advanced training in specific areas such as neurology and endocrinology. And those of us with chronic illness see a quantity by specialists.

Massage therapists, acupuncturists, chiropractors, and other non-traditional Practitioners who help people with chronic pain are also considered specialists, which means that insurance plans don’t always cover their benefits. A single visit to a massage therapist can cost $ 100 or more. Since you usually need multiple visits to get results, the bills add up quickly.

This does not apply to the specialist appointments, which you can just wait to be diagnosed. People with Autoimmune diseases For example, where the immune system attacks itself it is sometimes difficult to get a diagnosis because it is difficult Illness.

Save on professional visits

Ask your primary care provider (PCP) whether they can refer you to a specialist in the network. If your plan doesn’t cover practitioners in the specialty you need, some insurance plans will give you the network tariff if you seek out a specialist outside the network instead.

Insurance can also pay for an uncovered treatment like acupuncture if you can show it medically necessary. This may require a prescription or reference from your PCP to explain the need.

Balance settlement

If you see a care provider that is not covered by your insurance or receive treatment, it is You are not covered (not even by an in-network provider) Fees for the remaining balance – hence the name “account balance”.

In contrast to deductibles, which patients can plan, residual bills seem to come out of nowhere. I was surprised by a balance sheet for a brief hospital consultation with a doctor outside the network. The hospital was on the network, but the provider wasn’t. Like many patients in similar situations, me I didn’t have the opportunity to choose anyone in my plan.

Save on billing

Good news: According to the Pew Research Center, 25 states have partial or complete laws against the settlement of surprise balances. See if your state is one of them on the map here.

If you receive a final invoice, you may be able to apply for insurance to cover some of the costs. First of all, however, make sure that the invoice is actually for the treatment you received as the billing departments are making mistakes.

transport

These costs show up in different ways. There is the transport price itself, which adds up to multiple dates after weekly or monthly trips. I drove many subway trains with specialists all over New York City and sometimes got a cab when the office was far from public transportation.

Then there are the long-term effects of missed appointments when you are not reliable Transport. Many of these appointments monitor treatment as well Recognize symptoms early; Without them, you could end up in a much more expensive ambulance to the emergency room.

Save transport

Skipping appointments is a bad idea. Your provider may be open to remote video check-ins, especially given the ongoing threat of COVID-19 in crowded medical facilities.

However, if your treatment needs to be personal, see if your care facility can provide non-emergency medical transportation (NEMT), which is usually free and insured for patients.

Aids, implants and devices

Seeing, hearing and mobility Tools are not cheap. Some (not all) insurance plans offer partial or full coverage for Durable Medical Devices (DME) such as wheelchairs and canes if the devices are deemed medically necessary.

There is a limit to the plans. For example, most only reimburse new wheelchairs every five years. And insurance companies generally don’t pay for equipment upgrades that aren’t medically necessary.

Disposable medical items are often associated with high costs because they have to be replaced regularly. For example, an EpiPen – the fastest way for people with allergies to self-administer life-saving medication during an allergy attack – gets its incredibly high price from the injector, not the drug itself. Patients often expect a fee of more than $ 400 for two EpiPens, even after the insurance has paid its share.

Testing

Blood tests and other diagnostic tools are a normal part of chronic illness for many patients. Your hidden costs usually don’t come from the doctor’s office, but from the laboratory the doctor uses, which may be outside of your insurance network. After the Affordable Care Act, insurance policies have become more choosy about the tests they cover.

More comprehensive procedures, such as CAT scans and MRIs, may require pre-authorization from the doctor before insurance pays them.

Savings on testing

If you can, ask if a test can be sent to a network lab for analysis or if a procedure is pre-authorized. Your provider may prefer a laboratory outside of your network. However, if he can explain to the insurer why he chooses this laboratory, the insurance company may provide coverage.

As you prepare for a major procedure, you can find out if the healthcare professionals involved will accept your insurance as specialists will be brought in for the job.

Limited working hours

Chronic health conditions take their toll when you work too. Pain and other symptoms can limit your ability to work full time or get in the way of your career Advancement. To make matters worse, appointments and procedures cannot always be scheduled around working hours.

Less work means less money, of course – and when you find yourself in a stressful or physically demanding career, illness can cause you to reevaluate your plans.

Multiple health conditions

One of the worst things about being a chronic disease is that you don’t always have one. Coexisting or “comorbid” conditions are common and each new diagnosis increases your overall medical costs. ONE Study by scientists in Singapore and Australia Patients’ expenses rose by 5.2 times for two chronic diseases and by ten times for a third.

Why is the cost so high? Vendors tend to treat each disease individually rather than addressing them all at once. Two diagnoses can mean two medication regimens and two specialists.

Changes in coverage

Insurance cover expires add up even if they only last a few weeks. Even if you are Insurance plans can change what you pay for. Patients may show up at the pharmacy only to be told that their guidelines no longer cover the medication.

Insurance deductibles

As you probably know, insurance deductibles can be a headache. A high-deductible health plan seems to make sense at first; If you see a doctor frequently, you will reach your deductible faster and the insurance will cover the costs. But it can be an expensive road to get there.

Save deductible

When you buy a health insurance plan (more on that later), the first thing you should do is estimate the total estimated cost of your health care for the coming year as best you can. What medicines do you take, how often and how much do they generally cost? How often do you visit the doctor each year and what additional payment will you be charged?

Chronic conditions can be unpredictable, making it impossible for you to perfectly guess your future costs. However, knowing your largest and most common health expenses can help you decide whether a high deductible plan makes sense. You can save overall costs by buying a plan with a high premium (the amount you pay each month) and a lower deductible.

Choosing the right insurance

All insurance buyers should read the fine print before choosing a policy. However, this test is particularly important for people with chronic diseases. The last thing you want to know is that your plan isn’t providing enough coverage for the practitioners or medications you need. A seemingly inexpensive policy can become expensive very quickly – or the cost prevents you from seeking care.

Most plans have a benefit summary for potential buyers to read on their website. You should note the following in the documents:

• Are your regular doctors and specialists on the plan’s provider network? When you visit a hospital or treatment center, are they on the network?
• Are Your Recipes Covered? Do you need the insurer’s permission before they can pay for certain prescriptions?
• If you are using medical devices, are they covered? How often does the plan pay for replacements?
• What medical procedures are covered and how much is offered? Is the amount enough if you need regular interventions?
• Does the plan accept applicants with pre-existing conditions?

With a plan that covers most of the vendors and supplies you need, you will be better off even if the policy includes a high sticker price.

How to find a new plan

Disability insurance

Disability insurance protects part of your monthly income if you are unable to work due to illness or injury. I would recommend it to people whose chronic illnesses could limit their ability to work in the future, especially if your income supports others. Most plans pay around 60% of your regular income per month, which can make a big difference.

Breeze is a Great one stop shop to compare disability insurances from several freight forwarders. You can opt for short-term or long-term coverage and choose the length of your waiting period (how long you want to delay the benefits if necessary). The levels of coverage vary widely – you can opt for as little as $ 500 or up to $ 20,000. With Breeze, everything is online and only takes 15 minutes.

Policy genius is another option for comparing disability insurance. The independent website has several quotes from reputable insurance companies that allow you to choose what suits your needs. Representatives answer questions online via a chat function.

One of the best parts of Policy genius is the variety of plans you can shop for Disability insurance and Life insurance, as well as Standard health insurance. Costs and coverage vary, but the website itself is always free to use.

Life insurance

It is wise for everyone to get life insurance, whether or not they have a chronic illness. In the event of your death, helping your family financially can work wonders. If you don’t have it and you have loved ones, I highly recommend opening a policy.

If you have an invisible disease To lend has one of the most flexible term life insurance policies out there.

Unlike most other carriers To lend does not require a medical examination. Since exams sometimes exclude people with health problems from taking out life insurance – or mark them as high risk, leading to much higher premiums – a policy without an examination can be the easiest route to life insurance for the chronically ill. You will answer some questions about your health in your first questionnaire.

The coverage amounts range from $ 50,000 to $ 1,000,000.

Health insurance

If you have a chronic illness or disability and don’t have health insurance, you are likely paying medical bills out of your mind. While not every policy is created equal, it cannot be denied that it can help you manage the costs associated with your illness or disability. It is therefore worth looking into the health insurance options that you live in.

Summary

Invisible diseases are by no means invisible in your bank account. Once you know the hidden costs, you can keep an eye out for them – and save money on chronic disease treatment in the long run.

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