The tragic outcome of a decision to minimize costs

My mom passed away last December to Stage V breast cancer metastasized to her liver. During this battle she developed ascites (an accumulation of fluid in the peritoneal cavity) as her liver failure progressed. This accumulation of fluid was not only extremely uncomfortable but painful as well. In an attempt to find symptomatic relief for the last months of my mom’s life, the oncologist presented us two options: we could come in to clinic weekly and be tapped to have the fluid drained or we could implement a permanent drain in her peritoneal space.

Per the doctor’s advice, we opted for the latter option. The doctor recommended this option because my mom was on blood thinners and this plan obviated the need to continually reverse her Coumadin dose. Thus this equated to less time for her in the clinic and was less expensive for the hospital and our family… or so we all thought.

Our insurance company approved the top of the line specialty drain for this procedure. After the procedure, the hospital provided us with the first batch of drainage supplies. My dad and I learned how to properly drain my mother and change her dressings. We got into a routine of draining every night before bed. There was a dramatic improvement in my mother’s quality of life due to the release of extra of pressure in her abdomen. All was copasetic until it came time to reorder our supplies.

“Hello Ms. Ball! I understand that you are reordering the drainage and dressing kits , unfortunately they are out of plan for your insurance.”

We were dumbfounded. How could the insurance cover a system in which they did not support the supplies?

“These are non durable goods and not covered. The cost of the kit will be 600 hundred dollars monthly with a deductible of 750 for the first month.”

Our jaws dropped.

Due to my mother’s illness she was no longer working and was waiting to receive disability benefits. Six hundred dollars a month was more than a third of her entire income on disability. Our oncologist was horrified to learn that the nondurable goods associated with the drain were not covered. He had no idea that this was the case. Our doctor had recommended this plan to not only reduce chances of infection but also minimize costs for our family. This knowledge would have altered his recommendation of treatment plan for our family.

Yet it gets better, the drainage system leaked, requiring dressing changes two to three times a day. These extra dressing changes increased our out of pocket expenses by two fold. The cost of maintaining this system was extremely prohibitive. We could either afford to pay our bills or pay for the supplies of this drainage system. Thus, we resorted to using non sterile dressings instead of the prescribed dressings. Our replacement dressings included sanitary pads, urinary pads, saran wrap, and the occasional paper towel.

Although these means were clever and much more cost friendly for us, they greatly increased my mom’s chances of a peritoneal infection. A peritoneal infection would have resulted in a hospital stay and a much more costly bill for both our family and the insurance company than the sterile dressings my mom needed. My mom always joked that the solution to our financial struggles with medical care costs was for her to just hurry up and die … which much to a young daughter’s dismay was the heartbreaking truth of our situation.

Alexis Ball is a patient’s daughter.

This story was part of the Costs of Care 2011 healthcare essay contest, with the goal of expanding the national discourse on the role of doctors, nurses, and other care providers in controlling healthcare costs.  These stories from care providers and patients across the nation illustrate everyday opportunities to curb unnecessary and even harmful health care spending on a grassroots level. 

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  • http://profile.yahoo.com/JYG5LDGOGYRJZZAWWHYSNMAVLQ Neil

    This is a sad story, and the current medical/insurance system is broken. But what is the tragic outcome? Did she develope liver mets/late stage breast cancer as a result of cost minimization as well?

  • southerndoc1

    Medical supplies, both those sold to patients and those sold to docs, are one of the more obvious rip-offs out there. I would guess that the cost of manufacturing a month’s worth of dressings was somewhere south of $20.

  • http://twitter.com/Hootsbudy John Ballard

    I see similar stories in my post retirement work as a non-medical caregiver. There is ample material for some enterprising journalist to go for one of the big prizes for reporting.
    Lots of low-hanging fruit. Hello TV, magazines, publishers, others? Anybody listening???

    • Steve

      John – great idea. If you see similar situations on a regular basis, then you might be a good person to write about them, because first-hand observations from people not overly emotionally involved are often the best.. Or find a person who can help you write. Get a few good examples written and then go shopping for a publisher. Most have editors who can help get any manuscript into proper form for publication. Once again, heat and light are a good way to get bad policies and practices changed.

  • petromccrum

    This is a sad commentary on the state of health care in this country. It does not matter whether you have insurance or not; we all are overpaying enormously for any treatment/supplies.
    We all most be more proactive in trying to change this situation. It is only going to get worse.

  • http://www.caduceusblog.com/ Deep Ramachandran

    I am sorry that you lost your mother. What a horrible situation. I often place these catheters in my practice and we do pre-authorizations to make sure that they are covered. I have never heard or run into a situation like this, where the catheter is covered, but the supplies are not, and would be very upset if I did. I can only imagine how upset you must have been. I know that our hospital recently changed to a cheaper device. We came to realize that a big reason it was cheaper what that it did not include the first few drainage bottles and sterile supplies, which the patient then had to order. While it would be covered by insurance, they would still have co-pays and deductibles for it, thus shifting more of the cost from the hospital to the patient.

  • StephenModesto

    The irony of absently minded leadership only adds to the sadness of this sample story. I still do not understand how the revenue tenders at the insurance carriers do not realize that the costs of home healthcare are significatnly less than acute care reimbursement. The very fact the pt was dischargesd home and then followed with at least a home health `team’ would have easily transitioned her database coding to reimbursement for those supplies which would have `kept’ her out of the hospital ICU. Computers can easily do those type of `thing’s nowadays. Yes, the story of this pt does present as a hospice category as well, but even at that, hospice home care is still less `expensive’ than ICU cost over run absurdities….and obviously the qaulity of life from the pt point of view/experience is intrinsically enhanced.

  • Molly_Rn

    Another example in the millions of them, of why we need universal single payer healthcare for all. This country is nuts when it comes to healthcare.

  • Steve

    What an awful situation. Have you contacted the regulatory agency that manages health care insurance in your state? From the other posts on here what you experienced just doesn’t sound right. You might be able to recoup some of your out of pocket expenses, and help others avoid the same treatment from this insurance carrier if you file and complaint and then be persistent. Talk to local media outlet advocates, political representatives, anybody in a position to bring heat and light. It could be a way to bring something good from what your Mother had to go through.