A Hospital Charged quite $700 for every Push of drugs Through Her IV
Claire Lang-Ree was during a laboratory coat taking a university class remotely within the kitchen of her Colorado Springs , Colo., home when a profound pain twisted into her lower abdomen. She called her mom, Jen Lang-Ree, a NP who worried it had been appendicitis and located a close-by hospital within the family’s insurance network.
After an extended wait within the ER of Penrose Hospital, Claire received morphine and an anti-nausea medication delivered through an IV. She also underwent a CT scan of her abdomen and a series of tests.
Hospital staffers ruled out appendicitis and surmised Claire was affected by a ruptured cyst , which may be a harmless a part of the cycle but also can be problematic and painful. After a couple of days — and a chemistry exam taken through gritted teeth — the pain went away.
Then the bill came.
Patient: Claire Lang-Ree, a 21-year-old Stanford University student who was living in Colorado for a couple of months while taking classes remotely. She’s insured by Anthem Blue Cross through her mom’s work as a pediatric NP in Northern California.
Total Bill: $18,735.93, including two $722.50 fees for a nurse to “push” drugs into her IV, a process that takes seconds. Anthem’s negotiated charges were $6,999 for the entire treatment. Anthem paid $5,578.30, and therefore the Lang-Rees owed $1,270.45 to the hospital, plus additional bills for radiologists and other care. (Claire also anted up a $150 copay at the ER.)
Service Provider: Penrose Hospital in Colorado Springs , a part of the regional health care network Centura Health.
What Gives: As hospitals disaggregate charges for services once included in an ER visit, a hospitalization or a surgery , there has been a proliferation of newfangled fees to extend billing. within the health field, this is often called “unbundling.” It’s analogous to the airlines now charging extra for every checked bag or for an exit row seat. Over time, within the medical industry, this has led to separate fees for ever-smaller components of care. A charge to place medicine into a patient’s IV line — a “push fee” — is one among them.
Though the most important charge on Claire’s bill, $9,885.73, was for a CT scan, in some ways Claire and her mom found the push fees most galling. (Note to readers: Scans are frequently repeatedly costlier when ordered in an ER than in other settings.)
That was so ridiculous,” says Claire, who adds she had previously taken the anti-nausea drug they gave her; it’s available in tablet form for the worth of a cup of coffee, no IV necessary. “It works rather well . Why wasn’t that an option?”
In Colorado, the typical charge for the code like Claire’s first IV push has nearly tripled since 2014, and therefore the dollars hospitals actually get for the procedure has doubled. In Colorado Springs specifically, the value for IV pushes rose even more sharply than it did statewide.
A typical nurse in Colorado Springs makes about $35 an hour. At that rate, it might take nearly 21 hours to earn the quantity of cash Penrose charged for a push of plunger that likely took seconds or at the most minutes.
The hospital’s charge for only one “IV push” was quite Claire’s portion of the monthly rent within the home she shared with roommates. within the end, Anthem didn’t pay the push fees in its negotiated payment. But claims data shows that in 2020 Penrose typically received upward of $1,000 for the primary IV push. And patients who did not have an insurer to dismiss such charges would be cursed with them. Colorado hospitals on the average received $723 for an equivalent code, consistent with the claims database.
“It’s insane the variation that we see in prices, and there is no rhyme or reason,” says Cari Frank with the middle for Improving Value in Health Care, a Colorado nonprofit that runs a statewide health care claims database. “It’s just that they have been ready to negotiate those prices with the insurance firm and therefore the insurance firm has decided to pay it.”
To put the entire cost in context, Penrose initially charged extra money for Claire’s visit than the standard Colorado hospital would have charged for helping someone give birth, consistent with data published by the Colorado Division of Insurance.
Even with the negotiated rate, “it was only $1,000 but a mean payment for having a baby,” Frank says.
n an email statement, Centura said it “conducted a radical review and determined all charges were accurate” and went on to elucidate that “an ER (ER) must be prepared for love or money and everything that comes through the doors,” requiring highly trained staff, plus equipment and supplies. “All of this adds up to large operating costs and may translate into patient responsibility.”
As researchers have found, little stands within the way of hospitals charging through the roof, especially during a place like an ER , where a patient has few choices. A report from National Nurses United found that hospital markups have quite doubled since 1999, consistent with data from the U.S. Bureau of Labor Statistics. In an email, Anthem called the trend of accelerating hospital prices “alarming” and “unsustainable.”
But Ge Bai, an professor of accounting and health policy at Johns Hopkins University, says when patients see big bills it is not only the hospital’s doing — tons depends on the insurer, too. For one, the negotiated price depends on the negotiating power of the payer, during this case, Anthem.
“Most insurance companies do not have comparable negotiating or bargaining power with the hospital,” said Bai. Prices during a state like Michigan, where Bai said the UAW union covers an enormous proportion of Michigan patients, will look very different than those in Colorado.
Also, insurers aren’t the wallet defenders’ patients might assume them to be.
“In many cases, insurance companies don’t negotiate as aggressively as they will , because they earn take advantage of the share of the claims,” she says. The costlier the particular payment is, the extra money they get to extract.
Though Anthem negotiated away the push fees, it paid the hospital 30% quite the typical Level IV emergency department visit in Colorado that year, and it paid quadruple what Medicare would leave her CT scan.
Resolution: Claire and her mom decided to fight the bill, writing letters to the hospital and checking out information on what the procedures should have cost. the value of the IV pushes and CT scan infuriated them — the hospital wanted quite double for a CT than what top-rated hospitals typically charged in 2019.
But the threat of collections wore them out and ultimately they paid their assigned share of the bill — $1,420.45, which was mostly coinsurance.
“Eventually it need to the purpose where i used to be like, ‘I don’t actually need to travel to collections, because this might ruin my credit score,'” says Claire, who didn’t want to graduate from college with dinged credit.
Bai and Frank say the state of Maryland can provide a useful benchmark for medical bills, since it sets the costs that hospitals can charge for every procedure. Data provided by the Maryland Health Care Commission shows that Anthem and Claire paid seven times what she likely would have purchased the CT scan there, and nearly 10 times what they likely would have purchased the emergency department Level IV visit. In Maryland, intravenous pushes typically cost about $200 apiece in 2019. A typical Maryland hospital would have received only about $1,350 from a visit like Claire’s, and therefore the Lang-Rees would are on the hook for about $270.
Claire’s pain has come a couple of times, but never as bad as that night in Colorado. She has avoided reentering an ER since then. After visiting multiple specialists back range in California, she learned she may need had a condition called ovarian torsion.
The Takeaway: Even at an in-network facility and with good insurance, patients can get hurt financially by visiting the ER. a couple of helpful documents can help guide the thanks to fighting such charges. the primary is an itemized bill.
“I just think it’s wrong within the U.S. to charge such a lot ,” says Jen Lang-Ree. “It’s just a touch side passion of mine to seem at those and confirm I’m not being scammed.”
Bai, of Johns Hopkins, suggests posing for an itemized explanation of advantages from the insurance firm , too. which will show what the hospital actually received for every procedure.
Find out if the hospital massively overcharged. The Medicare price lookup tool are often useful for getting a benchmark. And publicly available data on health claims in Colorado and a minimum of 17 other states can help.
Vincent Plymell with the Colorado Division of Insurance encourages patients to succeed in out if something on a bill looks sketchy. “Even if it isn’t an idea we regulate,” he wrote in an email, departments like his “can always arm the buyer with info.”
Finally, make scrutinizing such charges fun. Claire and Jen made bill fighting their mother-daughter hobby for the winter. They recommend pretzel chips and cocktails to spice up the mood.