Costs of Methotrexate, TB test and Humira for rheumatoid arthritis: New year, new insurance

Filed Under: Costs, Health plans, Patients

She sent in several blood tests with substantial charges from the Mayo Clinic health system, with insurance via an employer. One was a basic metabolic panel, for which she was charged $138, and asked to pay $105 after the insurer’s writedown. She had a TB test too, for $104.

She commented: “on top of this was another $32 for blood draw. This is routine bloodwork done for rheumatoid arthritis.” She’s insured via an employer — and this is where it gets interesting, because her insurance plan got a lot worse recently.

We had an exchange by email. Here are my questions and her answers.

1. They did three tests — not just the arthritis one, but also the simple metabolic test and the CBC test. (They were all really expensive.) Was this for a regular checkup, or some other circumstances?

She said: “I’m on a drug called methotrexate. Its kind of hard on the body, especially the liver so I need to get my blood checked once every three months.”

2. Why were you asked to pay? Have you not met your deductible, or are they out of network?

She said: “that’s another really crazy thing. My employer pays for my insurance. blue cross blue shield silver, In Dec. we’re supposed to pick between 3 insurance options. I was ok with my insurance before so I said to let it be the same one. My copay for the rheumatologist was $60 per visit. I was ok with that. Then this year I went to the dr and got a bill for over $180. I said that can’t be right, I had always paid $60. The clinic assured me they were right. and they were. When I called the insurance company, it seems Blue Cross, Blue Shield MN silver wasn’t what it used to be. Seems now have to pay out the first $2500, then they pay 80% up to $4500, then pay everything. this is after the nearly $700 per month premium! When I asked about it, the answer I got was ‘the insurance policy is the same, but the insurance policy has changed’. How’s that for craziness?

3. Have you ever asked in advance the cost? Or have you had this test/these tests elsewhere and thus are familiar with how expensive these are?

She said: “I had been getting them at another clinic for the last 5 years or so but I’m going to need to go on Humira and needed a TB test (which the other clinic didn’t give) and figured it was easier to get it all done at once.”

She added: “something that just came up. the humira. Very expensive! $5000+ per month! (another story!). Methotrexate wasn’t working well so I needed something stronger. Dr prescribed Humira. I call the pharmacy to get the ball rolling and they said that they would need to get approval from the insurance company. 6 weeks later I get a mail saying I needed a TB test. Dr. sent orders to the clinic who weeks later said they didn’t do them. Waited a few weeks more to hear that. Made an appt with mayo in springfield mn for blood draw, and waited some more. Insurance co then claimed that I was already on the stuff and they weren’t going to pay double. I wasn’t. 3 months later and I still don’t have the medication. Saved themselves about $12,000 for messing with me because they didn’t have to pay for that expensive drug.”