How much will a sprained ankle cost me in the ER?
You sprain your ankle badly, and aren't sure if it's broken. It's Friday evening, so you head to the ER to have it x-rayed. At triage you ask 'how much might this cost me?' Typically, nobody working in the hospital at that moment will be able to even take a guess.
A landmark study published in PLOS ONE by researchers at UCSF looked at the billed charges for over 8,000 emergency department visits across the United States. Charges are what the hospital lists, not what anyone actually pays, and they ranged wildly for identical conditions: Sprains and strains: $4 to $24,110. Headache: $15 to $17,797. Kidney stone: $128 to $39,408. Upper respiratory infection: $19 to $17,421.
Why such extreme variation?
That study did not try to explain the spread, and says so: it did not adjust for which facility treated the patient, or for whether sicker patients drew higher charges. A second study from the same UCSF group did adjust, using 2011 charge data from every nonfederal hospital in California. Hospital and market characteristics, wages, patient mix, local cost of living, explained only 30 to 41 percent of the difference between hospitals. The rest is unexplained. Charges anchor instead to the 'chargemaster', an internal price list that works as an opening position: uninsured patients often face the full amount, while insurers negotiate steep discounts.
What can you do about it?
First, consider whether the ER is necessary. Many sprains and minor injuries can be evaluated at urgent care centers for a fraction of the cost. Second, if you do go to the ER, know that you can negotiate. Request an itemized bill, compare it to Medicare rates, and ask about financial assistance programs.
At My Doctor Medical Group, we help our patients navigate these decisions before they arise. Having a doctor who understands the cost landscape and can guide you to appropriate, cost-effective care is one of the many benefits of concierge medicine. Sometimes a phone call to your doctor at 6pm on a Friday can save you thousands of dollars and unnecessary stress.
