Behind the Numbers on Your Hospital Bill

Mar 27, 2014

In the emergency room, the last thing you want to think about is what your bill is going to look like. But, weeks later you will receive a bill in the mail; and you might experience some sticker shock.

Today on River to River, we seek to answer your hospital billing questions. Questions like: why does an aspirin cost upwards of $15, when I can get a generic bottle at the drug store at 2 cents a pop?

Guest host Emily Woodbury talks with Dr. Thomas Striegel, an emergency room physician at St. Luke’s Hospital in Cedar Rapids, and hospital administration expert Daniel Zismer, from the University of Minnesota’s School of Public Health.

We also take stories and questions from our listeners. Hear the conversation below; and scroll down to read stories from Iowans who saw a strange charge on their bill, and decided to inquire.

Please note: Economists often cite hospital pricing as the most complex, convoluted system in the health care industry. While our experts cannot speak to the exact reasons behind specific ER bills, they share some insight into why they look the way they do, and why there is more to the cost than you would think.

Ron Smith, Indianola

Ron and his wife had a bat in their room while they were sleeping, and they needed a rabies vaccination ASAP. The only place they could go was their local hospital. They knew that their bill would be expensive, but they had no idea that it would cost them thousands.

Sticker Price: $24,240

Actual Cost: The insurance company negotiated $17,627 off the bill - insurance covered $2,135 - the Smith’s were responsible for $4,482

Takeaway: “This was not a situation where we needed critical care. The shots could have been administered at a more cost effective venue.  If we had not had insurance, I was told by the hospital that we would have had to pay total costs of over $20,000. It seems that people without means pay the highest price for services.”

Q: Why did it cost so much?

A: Hospitals have to shift costs –

Seamus O’Brien, formerly of Dubuque

Seamus frequently works with his hands and in the past few years, he has had to get stitches twice. The first time, he went to the ER and received 7 sutures...and a fairly large bill.

Sticker Price: Stitches typically cost between $200-$3,000, and they can fall towards the higher end when administered in an ER

Actual Cost: Seamus paid a $500 deductible, and about $50 for remaining costs

Takeaway: “Since that occasion, I had a circumstance where I required about three sutures. I thoroughly washed, stitched, and protected the site. Three weeks later, I found I had no paperwork to complete, no infection, and best of all, I was $500 richer. Since then, I have had great cause to re-evaluate the benefit of going to the ER, unless it is a true emergency.”

Q: A trip to the emergency room may seem like the first choice when your doctor’s office is closed; but is it the right one? And stitches are so simple…why would they cost so much?

A: The ER is not always the place to go – and you’re not paying simply for your procedure, but for the expertise and range of options you have available when you walk into an ER –

Jan Gerstner, Delafield WI

Jan ended up in the ER after a recovery from a heart surgery left her feeling weak. She said that the hospital would not allow her to use the prescription medications she already had, and she received a pretty high price for the aspirin she was given.

Sticker Price: $300 for aspirin

Actual Cost: The insurance company paid for everything after her deductible was met

Takeaway: “I had requested detailed listing of the bill and had to pursue the hospital at length to get a complete accounting. I am still not certain that I got all of it, but after comparing what they gave me to the insurance statements over the next 6 months, I realized that a lot of money was paid out for otherwise un-detailed costs."

Q: Why do medications cost more at the ER than they would at the pharmacy?

A: You are not paying for a pill, but much, much more – and there is a lot going on behind the scenes that you are unaware of –


Find yourself wanting more?

Iowa Public Radio will continue looking at the cost of emergency room care over the next few weeks. In the meantime, check out IPR's new Tumblr page, where we will share snippets of our reporting along the way.

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