Most (if not all) of us know that treating cancer is not cheap.

During my first year of treatment, my insurance was billed approximately $250,000, which covered blood tests, x-rays, bone marrow biopsies, stem cell collection, appointments, infusions, and other various and sundry expenses throughout the year.  Since I was part of a clinical trial, the costs of Revlimid ^[1] (lenalidomide) and Kyprolis ^[2] (carfilzomib) were not billed, otherwise the cost would have been almost doubled.

During my second year of treatment, the total billed to insurance was "only" $125,000, primarily due to less frequent infusions, fewer blood tests, and no x-rays or stem cell collection.  Again, if the chemo drugs had been billed, the cost would have been over $350,000.

Interestingly though, the amounts actually covered by insurance each year were $162,000 and $70,000 respectively. As explained to me, the differences between the billed amounts and the paid amounts are due to discounts the insurance company has negotiated with the various medical providers.  Depending on the insurance company and the medical provider, the billed amount and the paid amount for services can be significantly different.

Thankfully, I have fairly good insurance through my employer.  However, as with many employers in the United States, the cost of insurance keeps going up and employees are asked to share more of the cost.  In my case, I have to cover $11,000 a year through deductibles and copayments, plus any uncovered costs in full.  While $11,000 is quite a lot of money, it pales in comparison to the total cost of my treatment, which would otherwise bankrupt me.

Even though insurance is covering the majority of my medical expenses, my wife and I have needed to be vigilant regarding the billed and paid amounts.  We have found errors on several occasions that would have cost either us or the insurance company several thousands of dollars.

Most often the errors are due to double billings.  This typically occurs when the insurance company takes too long to process a claim, or we do not pay promptly enough.  Generally the insurance company detects this and voids the second billing, but on a few occasions we've had to call the medical provider or the insurance company to clear it up.

A second source of double billing occurs when a medical provider wraps several charges up in a single billing, but then doesn't seem to apply the payment correctly and subsequently bills one or more of the items from the conglomerate claim separately.  This is the most difficult to clear up and usually requires a lengthy discussion with the billing department for the medical provider.

Other erroneous claims occurred when we were billed in full for something that was supposedly not covered by insurance but should have been.  This was usually due to the medical provider submitting the wrong code or providing insufficient information for a claim, and was typically cleared up through calls to the insurance company or medical provider.

While some errors are bound to crop up due to the number of claims that are processed, and can then be corrected, it unfortunately has required my wife and I to compare the billings from medical providers to the insurance payments and review the details associated with them when they differ.

Fortunately, I am an Excel master, so I set up a spreadsheet tracking the billings to insurance and their payments.   My wife is a CPA with a knack for numbers and weeding through the idiosyncrasies of billings, payments, etc., so she digs through the spreadsheet and makes sure everything balances.

My wife also handles most of the calls with the insurance company and the billing departments of the medical providers, which is a blessing to me since I hate dealing with this kind of stuff.

Left to deal with it on my own, I might end up handling it like one of the other patients I became friends with over the course of my treatment.  He figured he had been overbilled and paid an extra $3,000 to $4,000 one year, but didn't plan to do anything about it since it wasn't worth the hassle of working through it with the billing departments and the insurance company.

I sometimes wonder whether it might be better to have a government-subsidized medical program similar to ones in other countries, which typically standardize treatments and payments, though I'm not sure whether that would solve the billing inconsistencies.  It might just make it less likely errors are caught, since the government might not be as diligent checking into claims as the insurance companies are.

I'm also not sure I'd like to give up the flexibility I currently have in choosing my treatment, even though it comes at a cost.

Peace, and live for a cure.