As I mentioned about six weeks ago, I ended up going to the hospital while I was on vacation in California. Of course one of the hospitals lost my insurance info so they sent me an itemized bill instead. I've posted it here so we can all laugh together at how much they've charged me for a few things. I've not included a couple of things because they didn't seem terribly unreasonable to me.
Promethazine 25AMP: $37.88
Sublimaze (fentanyl) 100mcg injection: $47.50
1000mL Normal Saline: $99.01
Contrast with Exam: $412.00
CT W/W/O Contrast: $2629.69
CT Pelvis W/W/O Contrast: $2355.70
Level 3 w/ MD/Nurse procedure: $699.43
Admin of IV Injection: $184.71
Self-pay adjustment: -$1321.54
First off, Promethazine is cheap. Dirt cheap. I don't have the AWP for the injectable form, because I forgot to look it up, but it's very inexpensive. Probably less than $1 in the quantities hospitals buy it in.
Secondly, Sublimaze has an AWP of 45 cents. I'm all for charging more than AWP to people, but not 105.56x over cost. In fact, it's likely that the hospital pays much less than 45 cents per dose for Sublimaze.
Normal Saline. One liter. $99? You've got to be kidding me. One liter of normal saline runs less than a dollar. I can't check the AWP for this, because we don't sell it at all. Anyway, I don't appreciate being charged, once again, at least 100x what the actual cost is.
Contrast, AKA Barium Sulfate. I consumed two 473mL bottles: 946mL of the stuff, which has an AWP of ~$64. In the quantities that hospitals buy it, I'm sure they're charged less than that. A 640% markup.
Administration of IV injection. I don't know precisely what that means, but it seems incredibly expensive.
Of course I won't actually be paying these prices, because they've been able to successfully bill my insurance company. My insurance company won't be paying these prices either — the little "Self-Pay" discount that they gave me is hilarious because it's not really much of a break at all. The reality is that if I were a big insurer, I'd be getting a much bigger break than that.
You'd probably see the price of the saline drop to zero. Not even a penny. You'd probably see the cost of the barium drop somewhere down to AWP, along with the cost of the Sublimaze. Promethazine would probably drop to around 10 cents. I'm sure the CT scans would be billed at a much lower rate as well, probably around $1000 a pop. I know this because I've seen what my insurer paid for these things when I had them done before back home in Boston.
Given US healthcare economics, I'm not really complaining. I work for the system, and being on that side of it, I don't have a problem with it so much. But I do have a problem with this kind of obscene price gouging. I felt like I should have gotten prescriptions for the Fentanyl, Barium, and promethazine, and had them filled at a regular pharmacy and saved myself some serious money — even if I didn't have prescription insurance. BYO prescription meds, as it were. (Of course that would have never worked because no normal retail pharmacy stocks those items regularly, but you get the idea.) Price gouging a captive audience to the degree that this hospital did seems VERY wrong to me. Morally and ethically wrong.
On a completely unrelated note, Sublimaze is a very aptly-named drug…
[tags]Medicine, pharmacy, economics, price gouging, healthcare, California[/tags]