Covid-19 Charges at Hospitals Can Vary by Tens of Thousands of Dollars, a Businesshala Analysis Finds

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Half the rates for intensive care requiring ventilators were less than $90,000, but they were $200,000. was above

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At New York-Presbyterian Weill Cornell Medical Center in New York, the cost of a critical-respiratory patient was approximately $55,182 if that person was insured by CVS Health. of the corporation

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According to hospital statistics, Etna. for UnitedHealth Group Inc. NS

UnitedHealthcare, the hospital’s declared rate is $64,326, while the price listed in hospital data for patients covered by Anthem Inc. NS

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The Empire Blue Cross Blue Shield was $94,357.

The range of prices shows how similar hospital services can generate widely disparate bills. Even during pandemics, and within the same hospital, prices often reflect the profit that an insurer has to make from discounts as well as the hospital’s market power to raise its rates.

A spokeswoman for New York-Presbyterian said it negotiates each insurance contract individually and the costs for patients vary greatly based on the care they receive, their coverage and their eligibility for financial aid. An Anthem spokesperson said the insurer’s rate appears higher because of the way the hospital calculates and discloses it, and shows that the hospital is treating sick patients. Aetna said rates vary for a number of reasons, while UnitedHealth said rates reported by hospitals do not reflect actual service costs.

During the pandemic, insurers waived out-of-pocket charges for COVID-19 treatment, so variable costs did not directly affect patients’ pocketbooks. According to the Kaiser Family Foundation, patients are now facing charges such as deductibles or coinsurance, which may depend on rates secretly negotiated by hospitals and insurance companies.

“Some people have limited insurance and they’re getting these crazy bills, and they’re saying, ‘I don’t know how I’m going to get it,'” said Adria Goldman Gross, chief executive of MedWise Insurance Advocacy. ” Patient-Advocacy Firm in Monroe, NY

A federal fund that can cover the cost of COVID-19 treatment focuses on the uninsured. As a result, many patients with private coverage may actually pay more out of their own pocket than those without a health plan.

Pricing data went public this year under a new federal requirement. Businesshala analyzed this data for hundreds of hospitals, compiled by Turquoise Health Company, to understand what the cost of COVID-19 treatment is. The analysis focused on private insurance, the kind offered by employers or purchased individually, and not on government-backed plans under Medicare or Medicaid.

The analysis included three types of hospital patients: those with severe respiratory illness who typically avoided treatment with ventilators; respiratory patients who require ventilators for at least four days; And patients who had a life-threatening condition known as sepsis, and may also need ventilators for some time.

The Journal examined rates for billing codes for the conditions most frequently associated with privately insured COVID-19 patients in claims analyzed by Milliman Inc., an actuarial firm.

The analysis looked at rates in more than 600 hospitals. In describing price ranges, the Journal excludes the most extreme figures until they have been verified directly with the hospital and insurer to ensure accuracy.

COVID-19 treatment does not have its own specified billing code. Since the code can be used for patients with other conditions as well, the prices listed in the data will not show any additional bumps in what insurance companies pay to hospitals specifically for COVID-19 patients.

There were some higher rates at the top end of the categories that hospitals said corresponded to the sickest, hardest-hit cases.

Patients admitted for COVID-19 treatment may need to be in the intensive care unit and ventilators to help them breathe. If their insurer stops covering out-of-pocket expenses for virus treatment, patients could face thousands of dollar bills that companies have negotiated.

“You will have no control over what services are provided and you will have no control over the cost,” said Susan Null, principal of SystemMedic Inc., a medical billing and patient advocacy firm in New City, NY.

For billing codes that reflect inpatient care requiring more than four days on a ventilator, prices in the middle of the range were about $90,000, the analysis found. However, in some cases the rates went above $200,000.

Kettering Health’s Hospital in Hamilton, Ohio lists a top rate of $115,604 for Humana Inc.

For billing codes for severe respiratory conditions that do not usually require a ventilator. It was one of the highest prices in the Journal’s analysis for that code.

This represents the rate for a particular patient who “represents a one-time, high-intensity case, forming an outlier,” said Michael Mehrter, chief financial officer at Kettering Health, which covers nine hospitals. He said the hospital’s contracted rate for that code with Humana is $22,000.

The price is roughly average in the journal’s analysis for that code.

A Humana spokesperson said the high price for an average patient “does not align with Humana’s contracting rate for this type of admission”.

Cigna listed at MemorialCare Orange Coast Medical Center in Fountain Valley, California Corporation

The $424,773 price for a ventilator billing code represents a Cigna patient who was in the hospital for 27 days. John Cassell, a senior vice president at MemorialCare, said the typical Cigna rate for cases with the same billing code that doesn’t require that much care is about $147,000. That figure is above the 70th percentile in the journal’s analysis for that code.

A Cigna spokesperson said “the isolated examples do not provide meaningful insight” when evaluating COVID-19 costs.

Another factor in rates: whether an insurer can bring a large number of patients to the hospital. Hospitals give better prices to those who can.

For a sepsis patient billing code usually associated with COVID-19, a multiplan Corporation

The price posted by George Washington University Hospital in Washington, DC was $76,795—more than twice the next highest rate listed for a different multiplan brand, according to the analysis.

Multiplan offers a network of doctors and hospitals that can be used by insurers and others. Jane Crawford, a spokeswoman for Universal Health Services Inc., said its rates apply since 2018 to just one patient at George Washington University Hospital, who is commonly treated for a condition commonly associated with COVID-19, such as sepsis. Bring in more business than the major insurance companies. DC is the owner of the hospital. “Organizations that bring in the fewest patients get the smallest discounts,” Ms Crawford said.

Multiplan spokeswoman Pamela Walker said published prices do not accurately reflect Multiplan’s pricing structure. The multiplan sets the price for each item or service, and does not bundle them into a single rate compared to the hospital’s published price, she said. Multiplan declined to provide an estimate for a comparable price, saying there were too few patients with the data to obtain accurate figures.

Anna Wilde Matthews at [email protected], Tom McGinty at [email protected] and Melanie Evans at [email protected]

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