Sarah Kliff has the incredible story of an emergency room visit for a Band-Aid that ended up costing $629. It's incredible because how could putting a Band-Aid on a child's finger possibly cost that much? And it's incredible because there's a real reason (albeit a ridiculous one) for it to cost that much.
Part of this story isn't really the whole story—but it's part of it. Malcolm Bird—a first-time parent—took his 1-year-old daughter, Colette, to the emergency room back in January when her finger was accidentally cut by her mother trying to clip the child's nails. They waited about 20 minutes, saw a nurse, then the doctor came in, explained why the finger was bleeding so much (lots of capillaries in fingertips) rinsed and dried the finger and put a Band-Aid on it. Putting aside the over-use of emergency rooms (it's a thing and definitely part of why medical costs are high, but not the key part of the story), how this unfolds is textbook for what's wrong with our medical system.
A week later, something else showed up at home: a $629 hospital bill for the Band-Aid and its placement on Colette's finger.
His insurance had negotiated the price down to $440.30, the amount Bird — who was still in his deductible — was expected to pay.
"My first thought was, how could this possibly cost $629?" Bird told me when we spoke in April. "So I wrote the hospital a letter, expecting them to say, yeah, that's a bit excessive, and lower the price."
That didn't happen. The hospital sent him back a long letter explaining why it would stick with the price. The fees, the hospital's leadership responded, were justified—and it ultimately sent his unpaid bill to a debt collection agency.
What Bird and his insurance company were expected to pay was $7 for the Band-Aid (yes, ridiculous)—and $622 for "the use of the facility and staff."
That's according to John Murphy, who is the chief executive of the Western Connecticut Health Network, in a letter to Bird explaining his bill. "We staff the emergency department 24-hours a day, every day of the year, and stand ready to treat whoever walks through our door, be it a gunshot victim or a patient with a stroke." Bird's "facility fee" of $622—negotiated down by the insurance company—is helping to keep the ER doors open. It's the fee anybody setting foot inside of the ER is going to pay, provided they can pay at all.
Renee Hsia, a professor at University of California San Francisco who studies emergency billing, tells Kliff that "I think there are going to be facility charges regardless of the actual service that will always be part of ER care. But where this father has a reasonable point is that when you look at the cost of the Band-Aid and the proportional overhead, it just feels really crazy." What's more, there's no way of knowing what your facility cost is going to be—they're not publicized and they're set by the individual institutions, with huge ranges. Her studies of "ER bills for common procedures showed that prices can vary from as little to $15 to as much as $17,797" and there's "no rhyme or reason" behind the amount charged as a facility fee.
In this case, Bird’s efforts to try to get to the bottom of the costs—including getting Kliff involved, and her asking questions—resulted in the bill being written off by the hospital. But intrepid reporters aren't going to be there to question any and every ridiculous medical bill. One solution—the only one that seems available in the short term—is new laws or regulations requiring transparency, so at least you'd know what just walking through those ER doors was going to cost you. But that's just informing the patient. If you're at an ER, you need emergency care and you're not going to be shopping around to see where it's going to cost you the least.