When your doctor says you have Crohn’s disease, it can be a relief to have a diagnosis, but you understandably have plenty of questions. And how to handle the medical expenses may be one of them.
Crohn’s disease is a chronic and sometimes painful ailment in your bowels. While there is no cure, treatments are available to control Crohn’s disease and even send it into remission for months or years. The costs of medical care can stack up during that time, so you should plan and prepare now -- if you have great health insurance or none.
Why? One study found that claims related to inflammatory bowel disease (Crohn’s and ulcerative colitis) covered by private insurance and Medicare Advantage (Medicare coverage sold through insurers) neared $23,000 per year. Out-of-pocket costs exceeded $2,200 annually for people with IBD. That didn’t include roughly $3,000 of wages lost per year by an IBD patient or costs of any therapy to help handle the symptoms.
Regular Medical Treatment
Your care starts with a doctor’s office visit. While costs may vary around the country, the average cost for one plan was $130 to $180 for an adult without insurance, or around a $30 copay if you are insured.
Depending on the severity of your Crohn’s, your gastroenterologist may prescribe:
- Anti-inflammatories like 5-aminosalicylates
- Milder steroids such as budesonide
- Stronger corticosteroids like prednisone
- Steroid alternatives called immunomodulators, such as 6-mercaptopurine, azathioprine or methotrexate
- Biologics like adalimumab (Humira), certolizumab pegol (Cimzia), or infliximab (Remicade) that you get by infusion or injection
Your doctor also may suggest you take various over-the-counter medications to relieve symptoms like gas, fever, or joint pain. And you may need to adjust your diet and take supplements for vitamins B12, folic acid, C, and D.
Your medication costs can vary widely. For example, prednisone is advertised online for as little as $12 to $21 per prescription, meaning a 30% insurance copay would be as little as $3.60. But a single dose of the biologic infliximab, for example, can cost from $1,300 to $2,500, which would make your copay $390 to $750.
Tip: Comparing prices among local pharmacies and online is always a smart idea. You may also want to look into medication assistance programs, offered by many pharmaceutical companies.
Fortunately, the Affordable Care Act has helped ensure that private insurers don’t consider chronic diseases like Crohn’s to be preexisting conditions. On the other hand, Medicare and Medicaid do not cover all commonly prescribed IBD medications, so you would need to check ahead.
Tips: The Crohn’s & Colitis Foundation has created a checklist you can use to compare how different insurance plans cover IBDs. And if you need help covering the costs of medications and treatments for Crohn’s, the foundation also offers a search tool to find companies and organizations that provide assistance. Plus, if you find medication unaffordable, many drug manufacturers advertise programs that offer discounts.
More Serious Medical Care
Over the years, painful symptoms send some Crohn’s patients to the emergency room or urgent care clinics. Bear in mind that an adult emergency room visit can cost hundreds of dollars before insurance, and an insurance company may disagree your symptoms were sudden or the trip was necessary.
Also, despite best efforts with treatment, between 40% and 60% of Crohn’s patients will need some type of surgery within 10 years after diagnosis. A bowel resection is colon surgery that many people with Crohn’s eventually get. Its total cost, before insurance kicks in, can exceed $24,000 for a laparoscopic procedure and $31,000 for traditional open surgery. Check with your plan to find out what your costs would be and whether your choice of hospital (in network or out-of-network) would make a difference to the cost.
Maintaining Mental Health
Staying emotionally and psychologically healthy can be tough when you have a chronic disease. Case in point: People with Crohn’s have rates of anxiety and depression higher than the general population’s.
Anxiety and depression are medical conditions. There is treatment for them. Your needs may make the average cost of $100 to $200 for a therapy session (before insurance applies) well worth it. Also, your doctor may be able to refer you to a support group that can help you develop strategies for managing Crohn’s-related stress.
Tip: You also can research nearby support and mentoring groups and chat boards on the Crohn’s and Colitis Foundation site.
Managing the medical and psychological treatment costs of Crohn’s while you deal with years of symptoms is not always easy. But there are ways to bring your bills down. Research your options actively and bring any concerns about affordability to your gastroenterologist’s attention.