‘An Arm and a Leg’: How much for stitches in the ER? Hard to gauge upfront

Reviewed by Kate Anderton, B.Sc. (Editor)Dec 5 2019

Sarah Macsalka had heard the stories about how expensive an emergency room visit can be, even for a minor complaint.

So when her 7-year-old son, Cameron, tripped and gashed his knee in the backyard, the ER was not where her family headed first. In fact, Macsalka did just about everything she could to avoid paying a big, fat bill to get Cameron's knee stitched up.

Ultimately, she failed.

Her adventure raises a big question: In a system where consumers are encouraged to "shop" for the best deal in health care, why is it so hard to get simple information, like a price?

On this week's episode of "An Arm and a Leg," we get some answers.

Instead of taking her son to the local emergency room for stitches, Macsalka took him to an urgent care clinic, one that provides patients with prices ahead of the service. There, the staff said stitching up Cameron's knee would cost $150.

But there was a problem. The clinic didn't have the topical anesthetic the doctor would need to numb Cameron's skin first.

"And Cameron is like screaming and crying," Macsalka said. "He doesn't take pain well."

So, reluctantly, the family headed to the local emergency room.

Macsalka tried to be a smart shopper there, too. When a staff member came to take her insurance information, Macsalka grilled him about how much the visit would cost.

"He was like, 'I don't know. Just walking through the ER [door] costs $600,'" she said.

To Macsalka, that sounded like a "facility fee" — a cover charge of sorts, separate from any health care services. And it sounded pricey. But she was over a barrel.

"The kid is still screaming and crying," she said. "His knee's a mess." She wasn't about to drive him back to the urgent care place and start over again.

They got the stitches in the ER. And, as it happened, the anesthetic wasn't very effective.

Macsalka said her son's screams were ear-piercing. "Yeah, Cameron's lungs did not give out," she said. "Those are very healthy lungs."

As it turned out, Macsalka's attempts to figure out what the final price would be weren't very effective either.  A few weeks after the ER visit, she got a bill for the doctor's services and paid it: $214 after insurance.

Then there was another bill from the hospital. One line: $2,824.

Macsalka went back into smart-consumer mode. She called the hospital billing department and asked if there had been a mistake.

Macsalka said the person she spoke with on the phone told her that "just walking through the doors" of the emergency room cost $4,200. That amount matches a number on her insurance statement — an amount before the insurance company's negotiated discount.

After that discount, the bill was $2,824 - and because Macsalka's family had a high deductible, they were responsible for paying it all.

Macsalka said she tried another tactic and asked the billing representative: What if I didn't have insurance? She said the billing rep told her: In that case, the hospital would accept 10% of its total bill to make sure it collected something. Without a negotiated rate from insurance, the total would have been about $6,000, so 10% would have been about $600.

It was more than Macsalka had hoped to pay. But less than $3,000.

"So I was like, 'Fine, cool, I’ll take it.' And she’s like, 'Oh no. You can’t because it’s already gone through your insurance company. So that’s not an option for you.'"

Having insurance — with a high deductible — meant Macsalka was on the hook for the $2,800 charge.

She wishes someone could have told her the price upfront.

"I would’ve said thank you very much. And walked out and gone back to our lovely urgent care and been like, Cameron, bite on this stick," she said.

For Episode 4, we also rounded up a hospital consultant and a journalist to better understand the perspectives of the hospital and insurance company.

Dr. Lisa Bielamowicz — founder of Gist Healthcare, and Sarah Kliff — who now covers health policy for The New York Times — share why health care price transparency is often so muddy.

Season 3 is a co-production of Kaiser Health News and Public Road Productions.

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