The Cost of Crohn’s Disease (Year One)
The spring semester of my second year of law school, I had the worst abdominal pain of my life. I’d been having similar issues on-and-off for the past year or so, including dramatic weight loss caused by the uncontrollable urge to vomit every time I ate. Multiple visits to student health services yielded nothing but instructions to take antacids.
One weekend in February, though, the pain that had been mostly tolerable became unbearable. I assumed I had a stomach bug (it was going around campus!), but when Monday rolled around and I still couldn’t eat or move, I went to student health services once again. They gave me fluids, observed me, and, after a few hours had passed and I hadn’t improved, put me in a cab and sent me to the ER.
I didn’t leave the hospital for nearly a week. At the ER, an X-Ray and an MRI showed that my appendix and intestines were severely inflamed, and I was admitted and put on IV antibiotics, steroids, and fluids while the doctors tried to figure out what was wrong with me. One CT scan, one colonoscopy, and countless episodes of SVU later, I was diagnosed with Crohn’s disease, a type of chronic inflammatory bowel disease that causes symptoms in the GI tract and beyond.
The grand total for this five-day hospital stay was 13,246.53.
This sum included: four nights in the hospital; consultations with surgeons, hospitalists, and gastroenterologists; IV steroids and fluids; one MRI, one CT Scan, one X-Ray, and one Colonoscopy. Of the $13,246.53 billed to me, once insurance paid what they allowed, $1,094 came out of my $1,800 deductible and $1,745 went towards my $3,600 coinsurance maximum.
You want to talk insurance? Let’s talk insurance. My insurance coverage is a combination of my school’s mandatory, basic insurance ($930/year) and my mother’s insurance (at the time, she paid $2,300/year to add me to her work plan). The school’s insurance covers basic services at student health services with no co-pay, but prescriptions aren’t covered. My mother’s insurance is a great and flexible PPO. But with my 26th birthday this month, I was just kicked off my mother’s insurance, and so I had to decide if I want to be insured primarily through the school ($3,038/year) or keep basic services with the school ($930/year) and pay for COBRA through my mom’s insurance ($410.06/month, including dental). Through COBRA, I can continue my coverage for up to 18 months. Ultimately, I decided to go with COBRA, since my doctor is not affiliated with the school and so my visits with him would be capped at three for the year, or I’d have to pay out of pocket ($$$) for those visits.
Since my diagnosis at the beginning of the year, I’ve had two more hospital stays (12 days in total, for which I was billed $56,932, $73 of which went towards my deductible and $1,854 of which went towards my coinsurance maximum), along with several office visits ($160 in co-pays). I switched doctors and medications along the way, and have had half-a-dozen MRIs, a few more CT scans, and a drain put in my abdomen through a non-surgical procedure. At the moment, I’m taking a pretty aggressive medication called Remicade (It’s made with mouse antibodies! Modern medicine.), which has worked well on me for the past few months. It’s delivered by infusion every 2 months, and costs $4,000 per infusion. I’ll likely stay on this medication for several years if it continues to work, or, if it stops working (which is somewhat likely), will go on equally expensive peer medications. Interestingly, all these medications are technically biologics, not regular drugs, so they likely won’t go generic as quickly or as cheaply as normal medication. I also take a daily medication called Imuran that costs $20 for one month’s supply.
Before I was diagnosed with Crohn’s disease, I (somewhat shamefully) didn’t pay much attention to my health insurance numbers. I rarely visited the doctor, and the random flu shot or pap smear could easily be handled by student health services. Insurance plans are definitely now more in the front of my mind as I consider future employment. I have a severe pre-existing condition, and, once I graduate, my insurance coverage and costs and my salary will be important in ways I hadn’t anticipated before I decided to attend law school. I’m so incredibly lucky to have supportive parents who have done a lot of the financial heavy lifting since I was diagnosed, but I can’t be dependent on them forever.
I wish I could say I have a plan for how I’m going to keep paying my medical expenses once I’m unable to be on COBRA anymore, but at the moment I’m just concentrating on getting through classes and learning to live with this challenging illness.
The author is in law school.