Posted on Feb 14, 2023
Nearly $50,000 a week for a cancer drug? A man worries about bankrupting his family
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https://www.npr.org/sections/health-shots/2023/02/14/ [login to see] /cancer-drug-high-price-could-bankrupt
After several rounds of treatment for a rare eye cancer — weekly drug infusions that could cost nearly $50,000 each — Paul Davis learned Medicare had abruptly stopped paying the bills.
That left Davis, a retired physician in Findlay, Ohio, contemplating a horrific choice: risk saddling his family with huge medical debt, if he had to pay those bills from the hospital out-of-pocket, or halt treatments that help keep him alive.
"Is it worth bankrupting my family for me to hang around for a couple of years?" Davis pondered. "I don't want to make that choice."
How much Davis will end up owing for his care remains unclear. One of the hospitals that has administered the costly drug is appealing Medicare's initial payment denials. And the family might not even know their total balance until Medicare rejects all the appeals.
But the uncertainty has compounded the stress of living with an aggressive cancer.
After several rounds of treatment for a rare eye cancer — weekly drug infusions that could cost nearly $50,000 each — Paul Davis learned Medicare had abruptly stopped paying the bills.
That left Davis, a retired physician in Findlay, Ohio, contemplating a horrific choice: risk saddling his family with huge medical debt, if he had to pay those bills from the hospital out-of-pocket, or halt treatments that help keep him alive.
"Is it worth bankrupting my family for me to hang around for a couple of years?" Davis pondered. "I don't want to make that choice."
How much Davis will end up owing for his care remains unclear. One of the hospitals that has administered the costly drug is appealing Medicare's initial payment denials. And the family might not even know their total balance until Medicare rejects all the appeals.
But the uncertainty has compounded the stress of living with an aggressive cancer.
Nearly $50,000 a week for a cancer drug? A man worries about bankrupting his family
Posted from npr.org
Cancer
Medical
Health
Drugs
Pharmaceuticals
Posted 2 y ago
Responses: 3
Specific to him, it sounds like it was a hospital error and not Medicare's fault (the hospital submitted the bill to Medicare and used the wrong coding on the diagnosis he had). Once the hospital resubmits the bill with the right codes it should be approved.
I often wonder about the "price" of drugs and medical procedures. How often do you see on your EOB that the hospital billed $2000 for something but was reimbursed $50 for it. If the negotiated priced between the insurance plan and the hospital network was for $50, then you have to assume that the $2000 nowhere reflects reality.
I often wonder about the "price" of drugs and medical procedures. How often do you see on your EOB that the hospital billed $2000 for something but was reimbursed $50 for it. If the negotiated priced between the insurance plan and the hospital network was for $50, then you have to assume that the $2000 nowhere reflects reality.
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Tough position to be in. My suspicion is that in the end he will be spared the possibility of bankruptcy. If not, for me I would opt to protect my family. There is no right or wrong answer in this situation
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