Preventive care for COVID-19 in the form of vaccination is available for free in the United States. But if you actually get sick and end up in the hospital, you will likely pay for your treatment. The amount you pay, though, depends on not just how sick you are but also where you live, which hospital you check in to, and what kind of insurance you have (carrier and specific plan).
Fair Health, an organization that tracks health care claims data, recently published a map that shows the average and median costs of Covid treatment by state. While those numbers are useful for illustrating broadly where Covid care is more and less expensive, they don’t offer insight to individual people seeking treatment.
In this post, we look at the cost of various care that makes up Covid treatment at 10 hospitals in Chicago (see Figure 1 for locations) to illustrate just how much a person’s bill depends on where they seek treatment.
Figure 1: Map of hospitals featured in this post (interactive version here)
Related: At the Leading Children’s Hospitals, Prices Are All Over the Map
Cost of Covid Treatment 1: Evaluation & Management of Critically Ill Patient
When a patient arrives in a hospital presenting with Covid symptoms, staff must first evaluate them to determine what kind of care they need. For the purposes of our this post, we looked at the cost of billing code 99291, officially called “Evaluation and management of a critically ill or injured patient, first 30 – 74 minutes.”
At the seven Chicago hospitals with prices posted for this billing code, costs ranged from $912 (at the two public hospitals included here) to $3,979 (see Figure 2).
Figure 2: Costs for billing code 99291 at seven Chicago hospitals
A few key takeaways from this data: first, these are gross prices, also called “sticker prices.” These are generally considered the starting point for negotiations with payers.
The amount payers actually pay hospitals for this care can vary widely. Consider, for example, Advocate: that hospital group’s website lists 57 insurance payers on its “accepted insurance” page; for some of those payers, Advocate accepts multiple plan types.
So while Advocate Trinity’s $3,979 is the highest gross price among the ones we pulled, it’s possible that insurance companies actually pay much less for this service. This is why CMS requires hospitals to publish negotiated prices rather than gross prices; the gross prices don’t reflect what payers actually pay.
Cost of Covid Treatment 2: Ventilation Assist and Management
The second Covid treatment whose costs we examined was billing code 94002: “Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing, hospital inpatient / observation, initial day” (see Figure 3).
Note the last two words there: “initial day.” The average hospital stay for COVID-19 was just over a week as of August.
Figure 3: Costs for billing code 94002 at eight Chicago hospitals
Here, the costs range from $393 to $3,183, a difference of more than 800 percent. Worth noting, though, is that the highest gross prices here are at a children’s hospital (Ann and Robert H. Lurie Children’s Hospital of Chicago). The gross cost likely reflects the unique complexity of performing these procedures on children.
Cost of Covid Treatment 3: Pulmonary Diagnostic Testing and Therapies
The third Covid treatment whose costs we pulled was billing code 94060: “Pulmonary diagnostic testing and therapies” – in other words, testing and treating the lungs (see Figure 4).
Figure 4: Costs for billing code 94060 at nine Chicago hospitals
Here, the range is again dramatic: $144 at the two country-run hospitals included and $1,473 at Thorek Memorial – a difference of more than 10x. Again, the actual costs negotiated with payers varies; Thorek Memorial, for example, lists 53 payers on its site that it works with.
Cost of Covid Treatment 4: Intravenous Infusions for Hydration Purposes
The final Covid treatment whose costs we pulled was billing code 96360: “Intravenous infusions for hydration purposes” (see Figure 5).
Figure 5: Costs for billing code 96360 at 10 Chicago hospitals
Here, costs were more tightly clustered but still ranged by about $600, from $243 at the county-run hospitals to $839 at Advocate Illinois Masonic.
Price Uncertainty Adds to Patient Stress
As we mentioned earlier in this piece, the prices noted here are gross charges, not negotiated rates. The actual amount a hospital gets paid for each of these types of care can vary widely depending on which insurance carrier is paying for the care.
The amount a patient pays, of course, depends not only on those negotiated prices but also on how much of their yearly deductible they’ve already paid and other factors.
And while CMS requires hospitals to publish all their negotiated prices for shoppable services on their websites, most hospitals are still not in compliance.
The result for patients is that it’s nearly impossible to predict what their care will cost. This in itself can lead to worse health outcomes, as uncertainty causes stress and stress causes a host of negative health outcomes.
Hospitals: We Can Help You Comply with Price Transparency Rules
There are no easy fixes here. While hospital compliance with the Hospital Price Transparency Rule can help make the cost of healthcare more visible, it won’t solve the problems of the US healthcare system overnight.
What’s more, many hospitals simply don’t have the resources necessary to comply. On that count, at least, we at Healthcare Data Analytics can help. Our team of data consultants can guide hospitals through the process of compiling, formatting, publishing, and maintaining their pricing data so that it’s compliant with CMS requirements.
If you’re interested in hearing more about this service, get in touch.
If you’re already compliant and are interested in knowing what other hospitals in your region charge, we can provide that information. Our analytics tools make it possible to see competitor rates so you can spot pricing trends, fuel payer negotiations, identify revenue opportunities, and more.
Finally, if you’re not sure whether your organization is currently in compliance with the Hospital Price Transparency Rule, we can show you with your hospital’s transparency score.