Ryan Wettstein Nauman was inconsolable one evening last December. After going to bed, the 3-year-old from Peoria, Illinois, kept crying and crying and crying, and nothing could calm her down.
Her mother, Maggi Wettstein, remembers worrying that it was a yeast or urinary tract infection, a problem she had faced during potty training. The urgent care centers around them were closed for the night, so around 10:30 p.m., she decided to take Ryan to the Carle Health emergency room.
The medical procedure
The emergency room wasn’t very busy when they arrived at 10:48 p.m., Wettstein recalled. Medical records show they checked in and she explained Ryan’s symptoms, including an intermittent fever. The toddler was triaged and underwent a nasal swab test to check for Covid-19 and influenza A and B.
Wettstein said they sat and waited to be called. And they waited.
As Wettstein watched Ryan in the waiting room play area, she noticed her daughter had stopped crying.
She actually looked good.
So Wettstein decided to drive them home. Ryan had preschool the next day, and she figured there was no point in keeping her up for who knows how much longer and getting stuck with a big emergency bill.
There was no one at the check-in counter to advise that they were leaving, Wettstein said, so they simply went home to bed.
Ryan went to her preschool the next day, and Wettstein said they forgot all about the trip to the emergency room for eight months.
Then the bill arrived.
The final bill
$445 for the combined Covid and flu test – during an emergency room visit in which the patient never left the waiting room.
The Billing Problem: Healthy Hospital Markup and Standard Insurance Rules
Even though Ryan and his mother left without seeking medical attention, the family was left owing $298.15 after an insurance reduction.
At first, Wettstein said, she didn’t remember Ryan being tested at all. It wasn’t until she received the bill and requested her daughter’s medical records that she learned the results. (Ryan tested negative for Covid and both types of flu.)
Although Wettstein said the bill wouldn’t break the bank, it seemed high to him, given that Walgreens sells a combined at-home Covid and flu test for $30 and can do higher-quality PCR tests for $145.
As part of the public health emergency declared in 2020 for the Covid pandemic, insurance companies were required to pay for Covid tests without co-pays or cost sharing for patients.
That requirement ended when the emergency declaration expired in May 2023. Now, patients are often the ones footing the bill — and emergency room bills are notoriously high.
“That’s a pretty good mark that the hospital makes,” Loren Adler, associate director of the Brookings Institution Center on Health Policy, told KFF Health News when contacted about Ryan’s case.
The rates that insurance companies negotiate with hospitals for various procedures are often based on multipliers of what Medicare pays, Adler said.
Lab testing is one of the few areas where insurance companies can often pay less than Medicare, he said – the exception being when the test is done by the hospital lab, which which often occurs during emergency room visits.
Medicare pays $142.63 for the common test Ryan received, but the family must pay more than double that amount, and the initial hospital charges were more than three times as much.
The hospital is “using its market power to make as much money as possible, and insurance companies are not very good at fighting back,” Adler said. An increase of a few hundred dollars is a drop in the ocean for large insurers. But for patients who receive unexpected bills, it can be a heavy burden.
Brittany Simon, public relations manager at Carle Health, did not respond to specific questions but said in a statement: “We follow policies that support the safety and well-being of our patients, which includes initial triage symptomatic patients to the emergency department. “
While Ryan’s family would not have had to pay for a Covid test during the public health emergency, it was the family’s insurer, Cigna, who did not have to pay this time around, since the family had not yet reached an annual deductible of $3,000.
A Cigna representative did not respond to requests for comment.
The resolution
Wettstein said she knew she could just pay the bill and be done with it, “but the fact that I never saw a provider, and the fact that it was just for a Covid test, seems to me breathtaking.”
She contacted the hospital billing department to make sure the bill was correct. She explained what happened and said the hospital representative was also surprised by the amount of the bill and sent it for further review.
“’Don’t pay this until you hear from me,’” Wettstein recalled.
Soon, however, she received a letter from the hospital explaining that the accusation was correct and supported by documents.
Wettstein believed she was avoiding any charges by taking Ryan home without being seen. Instead, she received a bill “which they verified I had to pay.”
“Like I said, it’s mind-blowing to me.”
Takeaways
Emergency rooms are among the most expensive care options in the nation’s health care system, and the meter can start ticking as soon as you check in, even if you check before receiving care.
If your problem is not life-threatening, consider an urgent care facility, which is often less expensive (and look for posted reviews to confirm if it is truly an urgent care clinic) . Urgent care centers near Ryan’s home were closed that evening, but some facilities remain open late or 24 hours a day.
In a way, Wettstein was lucky. KFF Health News’ “Bill of the Month” got tips from other patients who left the ER after a long wait without seeing a doctor — and were charged a facility fee of more than $1,000 .
It is difficult to decide where to go, especially in a stressful situation, for example when the patient is too young to communicate what is wrong. Trying to understand what is happening physically with a 3 year old can seem impossible.
If you decide to leave the emergency room without treatment, don’t just walk out. Tell the triage nurse you are leaving. You might get lucky and avoid some fees.
Wettstein won’t hesitate to take Ryan to the pediatrician or an urgent care center the next time she’s sick. But Wettstein said, after receiving this bill, “I’m not going to create a habit by going to the emergency room.”
Bill of the Month is a participatory survey carried out by KFF Health News And The Well-Being of the Washington Post which dissects and explains medical bills. Since 2018, this series has helped many patients and readers reduce their medical bills, and it has been cited in states, at the U.S. Capitol, and at the White House. Do you have a confusing or scandalous medical bill you want to share? Tell us about it!
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of KFF’s primary operating programs, an independent source of health policy research, polling and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article was first published on KFF Health News and is republished here under a Creative Commons license.
