How much will a sprained ankle cost me in the ER? Somewhere between $4 and $24110. #costsofcare

You sprain your ankle badly, and aren't sure if it's broken or not. It's 6pm on a 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 new study out of UCSF, to be published in the upcoming issue of the open-source jornal PLoS ONE, looked at the bills for over 8000 emergency department visits for the ten most common ER diagnoses for patients between 18 and 64

years of age. The results, while not surprising to me, highlight how much financial risk you take walking into a hospital in the United States.

The prices for common conditions ranged widely. While this might reflect severity of illness and necessary diagnostics, the range of prices far exceeds the range of potential complexity:

• Sprains and strains:  $4 to $24,110.
• Headache: $15 to $17,797.
• Kidney stone, $128 to $39,408.
• Urinary tract infection? $50 to $73.002.

These are “charge master” charges (list prices), the prices that cash-paying patients are asked to pay, and that for the basis of discounts given to insurance companies. These results are consistent with the recent treatise in Time magazine by Stephen Brill on billing practices in the insurance industry (a must-read article).

Link to source article in PLOS One

What can we do given the unpredictability of prices at most hospitals?

1. Cultivate a relationship with a medical doctor who can help you navigate the hospital in the unlikely event that you need to use one.
2. Have a doctor who is available enough to take care of things that don't require a hospital, outside of the hospital, in a timely fashion.
3. Have some kind of catastrophic insurance that will keep you from bankruptcy in the event of a sprained ankle. A policy without a low maximum payout amount.

Here in San Francisco you can always choose My Doctor Medical Group as your medical home and advocate, to help avoid some of the avoidable uncertainty and lack of transparency in the larger health care system.