Further research by Susan Handlesman:
Factors relevant to COVID-19 and healthcare costs in McHenry County:
1. Healthcare insurance premiums are higher in McHenry County than Cook and other counties. Premiums of private sector insurance follow ACA marketplace rates.
- McHenry County Cheapest bronze plan for 58-year-old female: $774
- Cook County $621
That is, 25% higher premiums cost due to living in this county.
2. If one has severe symptoms suggesting COVID-19, what will the personal financial costs be?
Medicare A patients even without supplemental plans* have low or zero costs for hospitalization–so long as it is for inpatient, not observation.
Medicare B patients seeing doctors for testing will only be responsible for 20% of Medicare -approved prices, and this co-pay amount should be below a month’s premium for Medicare supplemental insurance.
Privately insured individuals will likely owe the entire cost of testing and treatment up to deductible amounts, as it is early in the year and deductibles have probably not been met.
It is important to note that the huge amounts billed are nonsense numbers meant to scare everyone.
The amount “allowed” is a much lower price. Note that copays are percentages of that allowed payment price.
If one goes to an out-of-network hospital for non-life-threatening emergency, one will be billed the full terrifyingly high rack rate.
If one receives inpatient care from an out-of-network provider (anesthesiologists, for example), one will be billed the full price of their rack rate.
Patients with insurance are rightfully concerned about seeking testing or treatment without first knowing their cost obligations…patients without insurance even more so.
1. Testing: assuming tests become available for wider range of indications, what will the cash price be?
HCPCS code U0001 is the billing code for testing but reimbursement rates have not been published yet (April 1 according to CMS.gov).
Anecdotal information suggests out of network (cash) prices billed for this testing range from $300 to $3000.
2. Treatment costs: only severely ill patients are receiving treatment for COVID-19. The costs at rack rate are typically reduced at least by 50% for cash payers.
A good method to estimate costs for COVID-19 inpatient care is to look at Medicare DRG (diagnostic related groups) reimbursement data. For DRG 207 Respiratory System Diagnosis With Ventilator Support 96+ Hours:
Here are ranges of average Medicare prices billed and average Medicare Reimbursement:
- Highest is UIC Chicago charge $246,000 reimbursement $55,000
- 4th is Sherman Elgin charge $192,000 reimbursement $41000
- Lowest is Mercy Hospital Chicago charge $55,000 reimbursement $45,000
This is website where you can look up a condition, click on that condition DRG description, enter your state, and obtain comparative hospital pricing information:Hospitalcostcompare.com/drgs
These circumstances (who can afford to write a blank check for an unknown cost of a test when there is no treatment (for non-urgent care)?) hamper efforts to collect data of value to researchers seeking preventive and treatment methods.
Treatment costs: insured or not, there are significant costs.
This may prevent uninsured or underinsured humans from seeking treatment.
But stepping back we see that a few years’ health ‘insurance ‘ premiums add up to the reimbursement costs to providers of a major lifesaving healthcare event.
The rest is lost to administrative costs and profits of third party intervenors who stand in the middle of —and dictate terms of —every health care transaction.
*(read David Belk MD website truecostofhealthcare.org , or Kaiser Foundation https://www.kff.org/medicare/issue-brief/how-much-could-medicare-beneficiaries-pay-for-a-hospital-stay-related-to-covid-19to understand that such plans are almost always a huge waste of money).