Ryan Wettstein Nauman was inconsolable one evening last December. After being put to bed, the 3-year-old girl from Peoria, Illinois just kept crying, crying and crying, and nothing could calm her down.
Her mother, Maggie Wettstein, recalled that she feared it might be a yeast or urinary tract infection she struggled with while potty training. The urgent care centers around them were closed for the night, so at about 10:30 p.m. she decided to take Ryan to the emergency room at Carle Health.
medical procedure
Wettstein recalled that the ER was not very busy when they arrived at 10:48 p.m. Medical records indicate he examined her and described Ryan's symptoms, which included intermittent fevers. The child was tested and a nasal swab test was conducted to detect COVID-19 and influenza A and B.
Wettstein said he sat down and waited to be called. And he waited.
As soon as Wettstein saw Ryan in the play area of the waiting room, she noticed that her daughter had stopped crying.
In fact, she seemed fine.
So Wettstein decided to take them home. Ryan had preschool the next day, and she thought there was no point in keeping him up any longer and getting stuck with a big ER bill.
There was no one at the check-in desk to tell them they were leaving, Wettstein said, so they went home to go to bed.
Ryan went to his preschool the next day, and Wettstein said they forgot all about the ER visit for eight months.
Then the bill came.
final bill
$445 for a combined COVID and flu test – from an ER visit in which the patient never made it past the waiting room.
Billing Issues: A Healthy Hospital Markup and Standard Insurance Rules
Even though Ryan and his mom left without seeing a doctor, the family owed $298.15 after the insurance deductible.
At first, Wettstein said, he didn't even remember Ryan being tested. She didn't find out the results until she received the bill and requested her daughter's medical records. (Ryan tested negative for COVID and both types of flu.)
While Wettstein said the bill isn't going to break the bank, it seemed like too much to him considering Walgreens sells Can do an at-home COVID and flu combination test for $30 and a high-quality PCR test for $145.
Insurance companies were required under the public health emergency declared for the Covid pandemic in 2020 To pay for Covid tests Without co-payment or cost sharing for patients.
That requirement ended when the emergency declaration ended in May 2023. Now, it's often the patients who pay the bill – and ER bills are extremely high.
“That's a very healthy markup that the hospital is making on this,” Lauren AdlerThe associate director of the Brookings Institution Center on Health Policy told KFF Health News when contacted about Ryan's case.
Adler said the rates insurance companies negotiate with hospitals for various procedures are often based on a multiple of what Medicare pays.
Lab testing is one of the few areas where insurance companies can often pay less than Medicare, he said — the exception being when the testing is done by a hospital lab, which often happens during ER visits.
Medicare pays $142.63 for the combined test Ryan received, but the family paid more than double that amount, and the initial hospital charge was more than three times that.
“Hospitals are using their market power to make as much money as possible, and insurance companies are not as good at pushing back,” Adler said. A markup of a few hundred dollars is a drop in the bucket for larger insurers. But for patients who get unexpected bills, it can be a huge burden.
Brittany Simon, public relations manager for Carle Health, did not answer specific questions, but said in a statement, “We follow policies that support the safety and well-being of our patients, including early testing of symptomatic patients in the emergency department. Is included.”
While Ryan's family did not have to pay for COVID testing during the public health emergency, it was the family's insurer, Cigna, that did not have to pay this time because the family had not yet met the $3,000 annual deductible.
A representative for Cigna did not respond to requests for comment.
Resolution
Wettstein said she knew she could pay the bill and get by, “but the fact that I never saw a provider, and the fact that it was just for a COVID test, to me Shocking.”
She contacted the hospital's billing department to make sure the bill was correct. He explained what happened and said that the hospital representative was also surprised by the size of the bill and sent it for further review.
“Don't pay for it until you hear from me,” Wettstein remembered being told.
However, soon after, she received a letter from the hospital informing her that the charge was true and supported by documentation.
Wettstein thought she was avoiding any charges by taking Ryan home without seeing him. Instead, she got a bill saying “they have verified I need to pay.”
“Like I said, it's amazing to me.”
takeaway
ERs are among the most expensive options for care in the nation's health system, and the meter can start running as soon as you check in — even if you check out before receiving care.
If your problem is not life-threatening, consider an urgent care facility, which is often (and is) cheaper. View posted notices To confirm whether it is actually an urgent care clinic). Urgent care centers near Ryan's home were closed that evening, but some facilities remained open late or around the clock.
In some ways, Wettstein was lucky. KFF Health News' “Bill of the Month” Suggestions have been received Other patients who left the ER without seeing a doctor after long waits — and were charged facility fees of more than $1,000.
Making decisions about where to go is difficult, especially in a stressful situation – such as when the patient is too young to tell what is wrong. It may seem impossible to keep track of what is going on physically with a 3-year-old.
If you decide to leave the ER without treatment, don't pass out. Tell the triage nurse that you are leaving. You may be lucky and avoid some charges.
The next time Ryan is sick, Wettstein won't think twice about taking him to the pediatrician or urgent care center. But, Wettstein said after receiving this bill, “I'm not going to make a habit of going to the emergency room.”
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