/She switched to an insurance plan that covered her treatment Her bill quadrupled

She switched to an insurance plan that covered her treatment Her bill quadrupled

TYLERTOWN – Klara Reid, 67, can make as much as $150 selling her homemade breads and jams at the Tylertown Farmers Market on Tuesdays. The petite, gray-haired woman, dressed in a peach button-down shirt with a short sleeves, bounces around tables, tempting customers with cinnamon rolls. A pink and purple cotton band is hidden under her left sleeve. This covers two IV inserts in her upper arm. She’ll then administer an antibiotic at home. Reid was diagnosed by her doctor with Mycobacterium complex in 2011. This is an incurable infection that affected her lungs, and she had to retire in 2013. She can now operate her market booth, which sells fresh vegetables, woodworking, and sometimes line dancing, because the antibiotics have reduced the severity of her infection. Reid’s insurance company covers her home infusion therapy for thousands of dollars per month. However, due to a recent plan change, her monthly out of pocket cost for supplies has almost quadrupled from $100 to $125 to over $400. This is about one fifth of Reid and her husband’s combined monthly Social Security checks. This price rise is common in today’s healthcare market, but it is still jarring for Reid and her husband, who are on fixed incomes and have difficulty understanding and coping with the sudden increase in costs. Even Tylertown’s busiest day, which has a population of 1,786 and a poverty rate at 28%, won’t make up the difference. “I can’t afford that amount of money.” Reid said. Reid stated that he doesn’t have the money. Despite President Donald Trump’s repeated promises of reducing rising healthcare and pharmaceutical costs, prices have continued to rise with seemingly no end in sight. Hospital costs have increased the fastest, while Americans are spending more on coverage. Family insurance premiums rose almost five percent between 2006 and 2018. Families are also spending more out of pocket for healthcare, as their deductibles have increased faster than the payments made by insurers (176 percent vs 48 percent), according to the Health System Tracker. This is a partnership between the Kaiser Family Foundation and Peterson Center on Healthcare. Reid’s bills, which have been more than $50,000 in 2019 for continuing care, are emblematic of broken promises and failed policies as well as political gridlock within the country’s health care system. According to Global Market Insights, the U.S. home-infusion therapy market was valued at $7 billion in 2017. It is projected to rise to $13.5 billion in 2024 due to rising rates of hospital-acquired infections and chronic disease. Reid stated that if Reid didn’t take the IV treatment, the bacteria would multiply and she would be admitted to the hospital. Then it would likely kill her. Reid was diagnosed with HIV and was given Medicaid. This is a government-run program that covers low-income individuals and the very sick. She was 65 when she switched to Medicare. This is a government-run health insurance program that covers the elderly. It does not cover homeinfusion therapy, or the supplies and pharmaceuticals associated with it. Reid was covered by a traditional Medicare plan. She had a small copay and could purchase any other medical supplies out of pocket for as little as $125 per month. She discovered that switching to a preferred provider plan with Humana would provide coverage for the entire treatment. She said, “We thought it would help with supplies.” She didn’t realize that her out-of pocket costs would be quadrupled if she contacted the private insurer. BioScrip Incfusion Services charges Reid $2,100 approximately every six days for IV supplies and medication. This includes a dressing kit ($5.74, Vitality Medical), two connectors ($1.39 Vitality Medical), and saline flushes (pack of 30, Amazon). A gravity flow dial drip line ($2.50 Save Rite Medical) as well as heparin flushes. Humana, her insurance company, offers a $1638 discount on the sticker price and pays $369.60. Reid is responsible for the $92.40 remaining approximately five times per month. Reid’s bill is nothing extraordinary. Reid isn’t sure she understands everything and the insurance company hasn’t provided any explanations to her satisfaction. Chief executive officer of National Home Infusion Association Connie Sullivan stated that BioScrip charges are comparable to, and possibly a little cheaper than, other infusion service providers. She explained that infusion therapy supplies are included in the price. This includes the cost of the pharmacy for all services, including sterile compounding, testing for contamination, and evaluating patient responses. “The problem with the service component, the patient doesn’t see much of it,” Sullivan stated. She was referring to various cost factors. Home infusion therapy is not covered by Medicare. Providers often find creative ways to make the service affordable to Medicare patients. Sullivan suggested that Reid likely received an indigent or charity discount before joining Humana. Reid has not been able to reach a resolution despite having conversations with her insurer and provider. After asking for one, Reid was unable to get a cost breakdown for supplies. It took her three months to receive it. “At Humana every person I spoke to through the chain would say, “Ma’am. I’m so sorry.” And I would reply, “Hun. I don’t want you sorry.” I want a solution. Reid stated that she couldn’t afford to continue paying this. Reid was told by BioScrip, Humana that infusion therapy would be less expensive at an outpatient clinic than it would at home. Reid visited the clinic last year for her treatment. For one month, she still has to pay the $1,000 bill. Mississippi Today did not reach out to BioScrip and Humana for comment. Reid does not blame herself for part of the bill. “I was sick… You’re too sick to think.” She said that someone needs to think for her. Reid is a high-energy individual by nature and finds it hard to cope with the slower pace of life over the past few years. She was paid by the production at her first job, in 1970s Tylertown Haspel factory. She assembled shirt collars in a matter of minutes and earned $5 per hour. This was more than twice the minimum wage. Reid stated that she was always active, busy, and efficient at what she did. It was difficult to slow down. Reid left the factory in 1979 to care for her children and Terry worked as a wireline operator offshore. Reid made wooden items, including door signs, napkin holders, paper towel and napkin holders, and dust catchers, which she sold at various festivals throughout the state. Reid opened a nursery in 1995 with six greenhouses for her husband. Reid believes she came in contact with nontuberculous Mycobacteria while working at the nursery. This is a common soil- and water-contaminant that could have led to her lung infection. Reid claims her doctor advised her. Reid is still part-time treasurer at Magee’s Creek Baptist Church where she attends. Terry, her husband, recently resigned from his position as county road maintenance supervisor to run for the Walthall County Supervisor’s seat. Their budget is squeezed even more by the fact that Terry and Reid also provide financial support for their two grandchildren. BioScrip recently informed Reid to stop purchasing her medication. Reid was able to find almost everything she needed online, including the necessary medical supplies. She paid just $100 for a three month supply. Reid is hoping to get a prescription for heparin, the only medication she can’t order online, with her doctor. Reid said that she said “Y’all are murdering me… I’m going have to die to get out debt with you’all,” recalling a conversation with BioScrip regarding her balance. I was actually laughing. I have a very dark sense of humor. It felt real at the time, because you get so frustrated.”