Covid-19 costs in hospitals can vary by tens of thousands of dollars, WSJ analysis shows

At the NewYork-Presbyterian Weill Cornell Medical Center in New York, the cost for a patient with severe respiratory conditions was approximately $ 55,182 if the person was insured by CVS Health Body

CVS -0.93%

Aetna, according to hospital data. For the UnitedHealth group Inc.

A H 0.43%

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

ANTME 0.84%

Empire Blue Cross Blue Shield was $ 94,357.

The range of prices shows how similar hospital services can generate very disparate bills. Even during the pandemic, and within a single hospital, prices often reflect the leverage an insurer has to compete for discounts, as well as the hospital’s market power to drive up rates.

A spokesperson for NewYork-Presbyterian said it negotiates each insurance contract individually and the cost to patients varies widely depending on the care they receive, their coverage and their eligibility for financial assistance. A spokeswoman for Anthem said the insurer’s rate seemed higher because of how it was calculated and disclosed by the hospital, and that reflected the hospital treating sicker patients. Aetna said the rates vary for a number of reasons, while UnitedHealth said the rates disclosed by hospitals do not reflect the actual costs of the services.

During much of the pandemic, insurers waived out-of-pocket costs for Covid-19 treatment, so variable costs did not directly affect patients’ wallets. Now, patients are increasingly faced with fees such as deductibles or coinsurance, which may depend on rates secretly negotiated by hospitals and insurers, according to the Kaiser Family Foundation.

“Some people have limited insurance and they get these crazy bills, and they say, ‘I don’t know how I’m going to get by,'” said Adria Goldman Gross, managing director of MedWise Insurance Advocacy, an advocacy firm. patients in Monroe, NY

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

Price data became public this year under a new federal requirement. The Wall Street Journal analyzed this data for hundreds of hospitals, compiled by Turquoise Health Co., to understand what Covid-19 treatment costs. The analysis focused on private insurance, the type offered by employers or purchased individually, and not on plans supported by the government under Medicare or Medicaid.

The analysis included three types of inpatients: those with severe respiratory disease who generally avoided treatment with ventilators; respiratory patients who have required ventilators for at least four days; and patients with a life-threatening illness known as sepsis who may also have briefly needed a ventilator.

The Journal examined the billing code rates for these conditions, which were the codes most frequently associated with privately insured Covid-19 patients in claims analyzed by Milliman Inc., a firm of actuaries.

The analysis looked at the rates of more than 600 hospitals. In describing the price ranges, the Journal has excluded the more extreme figures, unless they have been directly verified with the hospital and insurer concerned, to ensure accuracy.

The Covid-19 treatment does not have its own designated billing code. Since the codes can also be used for patients with other conditions, the prices shown in the data would likely not reflect any further increases in payments that insurers give to hospitals specifically for Covid-19 patients.

At the high end of the ranges were considerably higher rates which the hospitals said corresponded to the sickest and most difficult cases.

Patients admitted for Covid-19 treatment may require stays in the intensive care unit and ventilators to help breathing. If their insurer stopped blocking out-of-pocket costs for treating the virus, patients could face bills in the thousands of dollars linked to prices negotiated by companies.

“You will have no control over the services provided to you and you will have virtually no control over the costs,” said Susan Null, director of Systemedic Inc., a medical billing and patient advocacy company. in New City, NY

For the billing code that reflects inpatient care requiring more than four days on a ventilator, prices in the middle of the range were around $ 90,000, according to the analysis. The rates in some cases, however, were well over $ 200,000.

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

for the billing code for severe respiratory conditions that typically do not require ventilators. It was among the highest prices in Journal analysis for this code.

It represented the rate of one particular patient that “reflects a high intensity one-time case, creating an outlier,” said Michael Mewhirter, chief financial officer of Kettering Health, which includes nine hospitals. The hospital’s contract rate for this code with Humana is $ 22,000, he said.

The price is roughly the median in Journal analysis for this code.

A Humana spokesperson said the higher price “does not match Humana’s contractual rate for this type of admission” for an average patient.

At MemorialCare Orange Coast Medical Center in Fountain Valley, Calif., The Cigna Corp.

The price of $ 424,773 for the ventilator billing code represented a patient from Cigna who was in the hospital for 27 days. Cigna’s typical rate for cases with that same billing code that don’t require such an amount of care is around $ 147,000, said John Cascell, senior vice president at MemorialCare. The figure is above the 70th percentile in the Journal analysis for this code.

A spokeswoman for Cigna said: “The isolated examples do not provide meaningful information” when assessing the costs of Covid-19.

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

For the billing code of the patient with sepsis commonly associated with Covid-19, a MultiPlan Corp.

The price listed by the George Washington University Hospital in Washington, DC, was $ 76,795, more than double the second highest rate, which was listed for a separate MultiPlan brand, according to the analysis.

MultiPlan offers networks of doctors and hospitals that insurers and others can use. Its rates applied to a single patient at George Washington University Hospital since 2018 who was treated for sepsis conditions commonly associated with Covid-19, compared to large insurance companies which generate more business, a said Jane Crawford, spokesperson for Universal Health Services Inc., which owns the DC Hospital. “Those organizations that bring in the fewest patients receive the smallest discounts,” Ms. Crawford said.

The published prices do not exactly reflect MultiPlan’s pricing structure, said Pamela Walker, spokesperson for MultiPlan. MultiPlan sets the prices for each good or service and does not bundle them into a single rate comparable to the price published by the hospital, she said. MultiPlan declined to give an estimate for a comparable price, saying there were too few patients with the data to get a precise figure.

Write to Anna Wilde Mathews at [email protected], Tom McGinty at [email protected] and Melanie Evans at [email protected]