His mother, Maggie Wettstein, recalled fearing it might be yeast or a urinary tract infection, which she was dealing with while potty training. Urgent care centers around them were closed for the night, so around 10:30 p.m. he decided to take Ryan to the emergency room at Carl Health.
Medical procedure
The ER wasn’t very busy when he arrived at 10:48 p.m., Wettstein recalled. Medical records show he checked in and explained Ryan’s symptoms, including intermittent fevers. The toddler was tested and given a nasal swab test to test for covid-19 and influenza A and B.
Wetstein said he sat down and waited to be called. And they waited.
As Wetstein saw Ryan in the play area of the waiting room, she noticed that her daughter had stopped crying.
Actually, he seemed fine.
So Wittstein decided to drive them home. Ryan had preschool the next day, and he figured there was no point in keeping him awake for who knows how long and getting stuck with a huge ER bill.
Wettstein said there was no one at the check-in desk to let him know he was leaving, so he just headed home to sleep.
Ryan went to her preschool the next day, and Wettstein said she forgot all about the trip to the ER for eight months.
Then came the bill.
Final bill
$445 for a combined covid and flu test – from an ER visit in which the patient never made it out of the waiting room.
The Billing Problem: Principles of a Healthy Hospital Markup and Standard Insurance
Although Ryan and his mother left without seeing a doctor, the family owed $298.15 after insurance discounts.
At first, Wettstein said, she couldn’t recall Ryan being tested at all. It wasn’t until she received the bill and requested her daughter’s medical records that she learned the results. (Ryan tested negative for both Covid and the flu.)
While Wettstein said the bill isn’t going to break the bank, it does seem high considering it. Walgreens sells. An at-home covid and flu combination test can be done for $30 and a high-quality PCR test for $145.
In 2020, insurance companies were required under a public health emergency declared for the Covid pandemic. To pay for a covid test No co-payment or cost-sharing for patients.
This requirement ended when the emergency declaration expired in 2023. Now, patients often pay the bills — and ER bills are high.
“It’s a pretty healthy markup that the hospital is making on that,” Lorraine AdlerThe associate director of the Brookings Institution Center on Health Policy told KFF Health News when contacted about Ryan’s case.
Adler said the prices that insurance companies negotiate with hospitals for various procedures are often based on a Medicare reimbursement multiplier.
Lab tests are one of the few areas in which insurance companies can often pay less than Medicare, he said — the exception being when the test is done by a hospital laboratory, which is often during ER visits.
Medicare pays $142.63 for the combined test Ryan received, but the family is on the hook for more than double that amount, and the hospital’s initial charge was more than three times that.
Adler said the hospital is “using its market power to make as much money as possible, and the insurance companies aren’t very good at pushing back.” A markup of a few hundred dollars is a drop in the bucket for major insurers. But for patients who get unexpected bills, it can be a huge burden.
Brittany Simon, Carl’s Health public relations manager, did not respond to specific questions but said in a statement, “We follow policies that support the safety and well-being of our patients, including treating symptomatic patients in the emergency department. Includes initial triage.”
Although Ryan’s family did not have to pay for the Covid tests during the public health emergency, it was the family’s insurer, Cigna, that did not have to pay this time, as the family had not yet met the $3,000 annual deductible. was
A representative for Cigna did not respond to requests for comment.
Resolution
Wettstein said she knew she could just pay the bill and be done with it, “but the fact that I never saw the provider, and the fact that it was just a covid test. It’s annoying for me.”
She contacted the hospital’s billing department to make sure the bill was correct. He explained what happened and said the hospital representative was also surprised by the size of the bill and sent it for further review.
“‘Don’t pay until you hear from me,'” Wettstein recalled being told.
Soon, though, he received a letter from the hospital stating that the charge was correct and supported by documentation.
Wettstein thought she was avoiding any charges by taking Ryan home unseen. Instead, he got a bill “that they confirmed I had to pay.”
“Like I said, it’s heartbreaking to me.”
the carrier
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 isn’t life-threatening, consider an urgent care facility, which is often cheaper (and Look for posted notices. to verify if it is indeed an urgent care clinic). Urgent care centers near Ryan’s home were closed that evening, but some facilities are open late or around the clock.
In some ways, Wettstein was lucky. KFF Health News’ “Bill of the Month” Suggestions received From other patients who left the ER without seeing a doctor after long waits — and were slapped with more than $1,000 in convenience fees.
Deciding where to go is difficult, especially in a stressful situation – such as when the patient is too young to tell what’s wrong. Trying to figure out what’s going on physically with a 3-year-old can feel impossible.
If you decide to leave the ER without treatment, don’t just walk out. Tell the triage nurse that you are leaving. You may get lucky and avoid some charges.
Wettstein won’t think twice about taking Ryan to a pediatrician or an urgent care center the next time she’s sick. But, Wettstein said, after getting that bill, “I won’t make a habit of going to the emergency room.”
Bill of the Month is a crowdsourced investigation. KFF Health News And The Washington Post’s Well-Being+Being which separates and defines medical bills. Since 2018, the series has helped many patients and readers reduce their medical bills, and has been quoted in statehouses, the US Capitol and the White House. Do you have a confusing or outrageous medical bill you’d like to share? Tell us about it!
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This Essay First published KFF Health News and is republished here under a Creative Commons license.