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Out-of-pocket expenses could be as high as $1,300.
The average cost of an inpatient admission for COVID-19 could exceed $20,000, according to the Peterson Center on Healthcare and the Kaiser Family Foundation. The Peterson-Kaiser researchers also estimated that the average out-of-pocket expense for patients with employer coverage could be $1,300, and that perhaps one in five people could face a “surprise” out-of-network bill.
These are estimates, not actual figures, and the researchers used pneumonia as a proxy for COVID-19. It is too early say what the actual costs associated with COVID-19 inpatient admissions will be.
The Peterson-Kaiser researchers arrived at these estimate by using a sample of inpatient pneumonia cases drawn from an IBM MarketScan database that includes 18 million Americans enrolled in health plans offered by large employers in 2018. They sifted through the claims for DRGs for pneumonia, with and without complications. More specifically, they zeroed in on DRGs 193 (“simple pneumonia and pleurisy with major complications"), 194 (cases with “complication and comorbidity”) and 195 (cases without complications).
They found that average total cost of treatment for an inpatient admission for pneumonia with major complications was $20,292; an admission with [not major] complications and comorbidity, $13,767; and without complications, $9,763.
As is typical with hospital costs and claims, the range across the country was large, from $11,533 (the 25th percentile ) to $24,178 (the 75th percentile).
The out-of-pocket costs were actually a bit lower for patients with major complications ($1,300) than those without complications ($1,464). People with complications or comorbidity may reach their deductible faster because of prior expenses, so the out-of-pocket expense tied to the pneumonia episode might be lower. Last week, many insurers have moved to waive out-of-pocket costs associated with testing for the presence of the SARS-CoV-2, the virus that causes COVID-19. But OOP for treatment is a different matter.
Surprise billing has been a hot topic, and there is bipartisan agreement in Washington about curbing the practice, although not necessarily agreement on legislation that would do so. The Kaiser researchers also found that 18% of patients with an in-network admission for pneumonia with major complications or comorbidities faced an out-of-network charge of some kind.