This is What I Do in My Spare Time

Health insurance plans. If I never see another one again it will be too soon! As I stated yesterday, the number of plans that I started with was 27. I am pleased to announce that I am down to 11 -- less than half.

Even more important, however, is the fact that I spoke with the most informative person at Georgetown University Hospital. After explaining my unique situation to her, Cheryl helped me out by giving me an idea of how much 6 weeks of radiation will cost a person. Not only that, she also went through all the plans that I had left and helped me eliminate two more HMO's and two more PPO's -- leaving me with 8 PPO's and 3 HMO's.

Let me just say that you really gotta be a nerd to get excited about this stuff -- trust me, I'm telling you from the first-person.

So, in case you were wondering what a 6-week session of radiation therapy will cost, it is roughly $70,000 for Intensity Modulated Radiation Therapy (IMRT). Keep in mind that this is the most advanced cancer treatment available anywhere. It is the best of the best. Anyway, if I were to walk through the door tomorrow without insurance and get this treatment, it would cost $70,000. However, most insurance plans negotiate a 40-50% reduction in price. So now with insurance, the price of the procedure drops to around $35,000 to $40,000. Most of this covers the cost of running the equipment and using hospital resources.

Now is where the insurance company really comes in. Most HMO's offer a plan where you pay a specific dollar amount (usually around $30) per visit. So for 5 days a week for 6 weeks that would be $900. The bad part is that many times not every part of the procedure is covered by the HMO. The part that is even worse than that is that if something isn't covered by the HMO, the patient is solely responsible for it meaning that even though you escape a $70,000 procedure for around $1,000, you may still end up paying a lot more in smaller procedures not covered by the plan. All that without the freedom to choose where you want to go and get treatment. This isn't a big deal for me now, but what happens if I need a different specialist and hospital in September?

I know that was confusing, but I hope you are staying with me.

Now switching over to the PPO side of things. PPO's generally make the patient pay a percentage of total bills instead of a specific dollar amount, generally around 10-20%. As you can imagine, the roof is a little bit higher than for HMO's. Recalling the $35K - $40K amounts, it is not out of the question for the out-of-pocket costs to be in the neighborhood of $4,000 to $5,000 out of a possible $70,000. The really good news about a PPO is the added flexibility. I can choose the doctor and the facility and the most I will pay out of pocket is about 30% of the negotiated rate even if they aren't in the PPO network. If they are, it stays at 10-15%. More importantly, every part of the procedure will be no more than 30% instead of paying all costs in the HMO plan. The other thing to keep in mind is that there is a $4,000 catastrophic limit usually when it comes to PPO's. I'll probably reach that and anything over that is covered without any copays necessary.

Whew...sorry about all that. I'm still trying to learn it as well and writing it out helps me understand it just a little bit better.

Finally, it looks like I've got my doctor picked out, too. I've heard several good things about him and he is supposedly known to be the head and neck guru at Georgetown University Hospital. More on this later!