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900662 tn?1469390305

Why the medical providers love us($$) & why insurance co's hate us-ok dislike us.

I found this on the Web,  I think this is partly why my Dr hasn't yet placed me on DMD.

According to a 1998 Duke University study, the average annual cost of MS exceeds $34,000 per person, with lifetime costs of more than $2.2 million.



For those with MS that have a public option, I would think it might difficult  for you to receive timely testing & DMD'S.

What is anyone's thoughts?

John..


8 Responses
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1045086 tn?1332126422
Actually, that might be good news John.  Think of it this way.  If the average annual cost is $34,000 and the average lifetime cost is > $2.2 million, then the average person is ......

living 65 years after diagnosis with MS!!

Mary
Helpful - 0
645800 tn?1466860955
Mary,

  It depends on how you look at it.

1) 65 years of this pain, cognitive dysfunction, numbness, and all of the other symptoms....YUCK!

2) 65 years before I die...Yeah that's the ticket

Dennis
Helpful - 0
1313843 tn?1275021437
Agree with Sailor,
I think i would settle for just being able to do everything on my own and then just leave this world. Hopefully it will be before i fall down and go into coma.

all the insurance companies will fight against a cure just so they can profit on people like us with M.S.

Now these days profit is what counts, life doesn't matter..if it does, then kids not going to kill parents for money or vice versa..so Insurance companies just want the profit and kill us slowly while making profit.

well i am making sense aren't I??



Helpful - 0
751951 tn?1406632863
If that study was done in 1998, has it been updated?  Were DMDs even on the market back then?  Today's costs could well be much higher.

I don't see any financial incentive for insurance companies to avoid a cure, if the cure is cheaper than the treatment.  That's why they often pay for birth control.  It's sure cheaper than pregnancy, labor, delivery, and treatment of whatever the kid might develop in its lifetime.

Drug companies, on the other hand, can obviously profit through people who use their product continually for the rest of their lives.

When Loretta worked in an office with 14 doctors, the drug companies' sales reps used to fight over which one got to cater the Friday luncheons for the entire staff, while presenting the latest information on their newest wonder drugs.  These weren't brown bag lunches, either.  Look at the note pads, pens, etc., lying around in your doc's office.  I'll bet they're all emblazoned with the names of drugs or drug makers, and I'd be willing to bet that the majority are for so-called 'maintenance" drugs that are prescribed for continual use for years to come.

I'm surprised we don't have more chemical treatments for things like gall bladder and appendicitis that are permanently cured with relative ease via surgery.  If there was enough money in it, you can bet somebody would've come up with it.  Can't you imagine the ads?  "Today, our advanced products often make old-fashioned surgical treatments unnecessary for many patients, avoiding the pain and inconvenience normally associated with laparoscopic cholecystectomies.  Ask your doctor if Bladdavert is right for you.  Side effects are rare and may include frequent wincing, compulsive gambling, poverty, or a strong urge to chase cars.  Your heath care provider can answer any questions you may have regarding these symptoms."

I really know nothing about the manufacturing costs for any of the current DMDs for MS, nor the costs for research that went into their development.  I can't help wondering where the money goes from discoveries made through research funded by charities, i.e., NMSS and similar organizations.  Do they get a cut of what the drug companies charge, if they helped bring the drug(s) into being?

The other issue that concerns me is that of "defensive medicine," in which providers order a broad range of tests for a seemingly simple illness, just to be sure that they didn't miss anything for which they could later be found liable.  On the flip side (and which I think we're seeing a lot of in this community), docs won't prescribe testing to rule out possibilities, fearing that the claims analysts (Loretta was one of those for about 15 years, too) will say that the tests weren't medically necessary and are therefore not covered.  Then the lab, imaging ceter, hospital, etc., has to collect from the patient, and that can often take a very long time, since few of us can pay for anything but our deductibles and copays already.
Helpful - 0
667078 tn?1316000935

Duke since they did that study they thought of a way to deal with loss of income. When I see my Neurologist I pay double my copay which comes to $120 out of pocket instead of $60 for my other Neurologist. They call it a Campus fee. Before every appointment, test or surgery they send a recorded message telling you how much money to bring. This comes before any instructions.


Here in Durham an MS provider loses money if he sees a patient more than 15 minutes because the insurance reimbursements are low because they basically follow medicare. One of the three neurological practices will not take medicare which many with MS are on, Duke doubles the fee, and the other you never see a Neurologist only a PA.

We have over 5000 MS patients and less than five MS Specialists, Two are retiring so people are scrambling to get on with one of the other three as fast as possible.

Yes Doctors do lots of tests I found this with my gallbladder, but in the old days they opened you up and did exploratory surgery or back in the 1960's when I had clear neurological issues the Mayo Clinic and Duke had no MRIs so it was noted and forgotten.

Lets face it with out insurance who among us could afford a hospital stay or DMDs or an MRI. I was amazed at the technology used on me in my 24 hour stay, things hospitals did not have in my last stay 20 years ago.

MS is expensive but so is Diabetes, Cancer, Heart Disease, and a whole host of other illnesses over a lifetime. My father had Cancer for 17 years and every treatment imaginable. My sister spent the last ten years of her life in and out of intensive care. My friends 40 year old husband had quintuple bypass last year, genetics. Another friend had Multiple Myleoma which was extremely expensive over two years.

I do not think Neurologists are holding back on DMDs. I personally think they are probably over prescribing them. The DMDs are shown to work on early RRMS 30% The trick is figuring out who that population is?

These drugs have some side effects and the patient has to be truly committed to the routine. I was until I found out they probably were doing me no good. It is hard to give yourself a stinging shot everyday if you think it is doing no good.

It takes about ten years to make a gallstone as big as mine. When they took the organ out they found it was extremely scared from the repeated inflammation. The best imagining could not show the Doctor what she found. Plus they have to do the imaging so the surgeon knows where to find your gallbladder and the bile duct since everyone is different.

Alex



Helpful - 0
900662 tn?1469390305
I sure wish this was disease prevention  course instead.

I'm just shocked at the cost for all of us, not just the monetary cost.

Our quality of life is more important than a few bucks,  I guess If we could buy good health we all would be in that  line.

I'm still coming to terms with my MS.

John..
Helpful - 0
1207048 tn?1282174304
(my head is a bit fuzzy, so sorry if I'm not talking about the correct topic!)

I think insurance coverage has a lot to do with the regulations in your state. Some states have far fewer requirements placed on insurance companies then others. I'm lucky enough to live in NY State, which has a good amount of requirements.

Three years ago I never would have known how lucky I am. My DH worked at a top National Bank for 10 years, in the mortgage division. Our area did not have the housing bubble like others...but even we were eventually effected. DH ended up leaving the company, and along with it the very reasonable insurance benefits (about $430 a month premium, free well baby checks to age 18, kids co-pays $10, our co-pay $15, $20 for a specialist. Rx coverage was $5, $10, or $25. No deductible, no lifetime max)

Long story short: My DH has had and left 2 jobs since then. He's been at his current one for about 6 months, and while he enjoys it greatly, and is very good at it and most likely on the fast track to advance quickly, there is no denying that we have taken about a 50% paycut from his old bank job. Add in the the insurance offered at his work is out of our budget (close to $500 a month premium, $20 co-pay, $50 specialist co-pay -I'd have paid my neuro over $200 this past month alone!- and horrible Rx coverage) and we would be in deep trouble living in any other state.

Our state has a state health plan, not medicaid (though they use medicaid for the Rx coverage) which is based on income. I have been very happy with this insurance plan, and did not feel I was getting lessor quality care. They covered a brain MRI in Feb, my doctor fought for a repeat brain MRI, along w/neck & spine in early April which they approved. They did deny another MRI at the end of April when the vertigo/first suspected attack happened, but while that was frustrating I understand why they denied it. I will be having repeat MRI's in November.

I've looked into the DMD and they are covered with prior authorization, so it might take a bit to get through the red tape, but I will get them.

Everything I've heard says that "state" health insurance will give you the worst coverage. My experience is the exact opposite.

Now drug companies..... I have a bit of a distrust of them....I think they could be moving things along quicker. But, I guess new versions of viagra and botox are more important.

~Jess
Helpful - 0
1318483 tn?1318347182
I, too, have found myself with state medical care.  I am single so when I lost my job, it ended all my family income.

I started with state medical in Ohio and found it satisfactory.  I always got tests that were requested, meds too.

I am now in California and still on state care.  The only problem I have run into with them is not being able to get Provigil and having a 7 prescription limit per month.  I currently take 9 different drugs a month...not counting anything that may come up.  My doctor has requested an exception to the limit and we are waiting to hear back about that now.  He seems to think they will approve it.

Any tests/specialists I have ever needed have been absolutely no problem with my insurance.  I have been happy with it.

If and when I happen to get a diagnosis, DMD are covered, too.

Addi
Helpful - 0
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