A Hospital Charged More Than $700 For Each Push Of Medicine Through Her IV

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Rose Wong for NPR/KHN

«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 price of a cup of coffee, no IV necessary. «It works really well. Why wasn’t that an option?

In Colorado, the average charge for the code corresponding to Claire’s first IV push has nearly tripled since 2014, and the dollars hospitals actually get for the procedure has doubled. In Colorado Springs specifically, the cost 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 would take nearly 21 hours to earn the amount of money Penrose charged for a push of plunger that likely took seconds or at most minutes.

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The hospital’s charge for just one «IV push was more than Claire’s portion of the monthly rent in the home she shared with roommates. In the end, Anthem did not pay the push fees in its negotiated payment. But claims data shows that in 2020 Penrose typically received upward of $1,000 for the first IV push. And patients who didn’t have an insurer to dismiss such charges would be stuck with them. Colorado hospitals on average received $723 for the same code, according to the claims database.

«It’s insane the variation that we see in prices, and there’s no rhyme or reason, says Cari Frank with the Center for Improving Value in Health Care, a Colorado nonprofit that runs a statewide health care claims database. «It’s just that they’ve been able to negotiate those prices with the insurance company and the insurance company has decided to pay it.

To put the total cost in context, Penrose initially charged more money for Claire’s visit than the typical Colorado hospital would have charged for helping someone give birth, according to data published by the Colorado Division of Insurance.

Even with the negotiated rate, «it was only $1,000 less than an average payment for having a baby, Frank says.

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In an email statement, Centura said it «conducted a thorough review and determined all charges were accurate and went on to explain that «an Emergency Room (ER) must be prepared for anything 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 can translate into patient responsibility.

As researchers have found, little stands in the way of hospitals charging through the roof, especially in a place like an emergency room, where a patient has few choices. A report from National Nurses United found that hospital markups have more than doubled since 1999, according to data from the U.S. Bureau of Labor Statistics. In an email, Anthem called the trend of increasing hospital prices «alarming and «unsustainable.

But Ge Bai, an associate professor of accounting and health policy at Johns Hopkins University, says when patients see big bills it isn’t only the hospital’s doing — a lot depends on the insurer, too. For one, the negotiated price depends on the negotiating power of the payer, in this case, Anthem.

«Most insurance companies don’t have comparable negotiating or bargaining power with the hospital, said Bai. Prices in a state like Michigan, where Bai said the UAW union covers a big proportion of Michigan patients, will look very different than those in Colorado.

Also, insurers are not the wallet defenders patients might assume them to be.

«In many cases, insurance companies don’t negotiate as aggressively as they can, because they earn profit from the percentage of the claims, she says. The more expensive the actual payment is, the more money they get to extract.

Though Anthem negotiated away the push fees, it paid the hospital 30% more than the average Level IV emergency department visit in Colorado that year, and it paid quadruple what Medicare would allow for her CT scan.

Resolution: Claire and her mom decided to fight the bill, writing letters to the hospital and searching for information on what the procedures should have cost. The cost of the IV pushes and CT scan infuriated them — the hospital wanted more than 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 got to the point where I was like, ‘I don’t really want to go 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 prices that hospitals can charge for each procedure. Data provided by the Maryland Health Care Commission shows that Anthem and Claire paid seven times what she likely would have paid for the CT scan there, and nearly 10 times what they likely would have paid for 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 the Lang-Rees would have been on the hook for about $270.

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Claire’s pain has come back a few times, but never as bad as that night in Colorado. She has avoided reentering an emergency room since then. After visiting multiple specialists back home in California, she learned she might have 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 few helpful documents can help guide the way to fighting such charges. The first is an itemized bill.

«I just think it’s wrong in the U.S. to charge so much, says Jen Lang-Ree. «It’s just a little side passion of mine to look at those and make sure I’m not being scammed.

Bai, of Johns Hopkins, suggests asking for an itemized explanation of benefits from the insurance company, too. That will show what the hospital actually received for each procedure.

Find out if the hospital massively overcharged. The Medicare price lookup tool can be useful for getting a benchmark. And publicly available data on health claims in Colorado and at least 17 other states can help.

Vincent Plymell with the Colorado Division of Insurance encourages patients to reach out if something on a bill looks sketchy. «Even if it’s not a plan we regulate, he wrote in an email, departments such as his «can always arm the consumer 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 boost the mood.

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!