Healthcare According To Ernie – The Great IV Bag Question

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As I prepare the content for this series I am now overwhelmed with all that I would like to share.  At the risk of seeming disjointed, I am going to post shorter observations more frequently and then post the continual storyline each weekend.  For those that follow this – look for this naming convention to keep things straight-ish 😉

Healthcare According To Ernie – Chapter X – this will be the main storyline

Healthcare According To Ernie – Misc Title – these will be the shorter observational pieces

Now on to this little tidbit – to set the context, I could not get a bill from Bayfront Medical Center – in fact I could not walk out of the hospital with anything, no records, no bill, not a thing.  They did finally figure out I had insurance (this saga will be covered in the next chapter of the story line) and captured that information right before I was discharged.  A couple weeks afterwards I received a very nice call from a woman in hospital billing informing me that I owed them $2,900.  That didn’t surprise me since that is my health plans deductible but I’m not accustomed to paying for something without some kind of invoice.  She told me that she couldn’t send me an invoice or a bill – only that I owed $2,900 and how would I like to pay for that.

She was truly very nice and I felt for her as I understand how silly this system is so I told her that I only had a couple hundred dollars in my HSA in cash and the rest was in investments and I needed time to liquidate it – not an entirely untrue statement.  We agreed that I would pay her $500 and she would in turn send me screen shots of the procedures that the hospital submitted to my health plan.  Once I had the money liquidated I would pay the balance.

When I received the screen shots in the mail I went through them and one thing caught my eye immediately – a charge for CPT code 96361 IV INFUSION HYDR for two units for a total of $801.60.  So I’m not dense, this is clearly the IV fluids I received and I did recall them hanging two bags while I was there.  $800 for salt water?  So I started exploring what this could have possibly cost.

The first thing I did was Google IV supplies and of course I found a myriad of online medical supply companies that would sell directly to me (with a prescription of course) all manner of IV bags.  I looked around and since I’m not a professional, I quickly noticed that there are all kinds of flavors of 1000ml IV bags.  Regardless I was able to determine a price range for online, retail supplies.  Bags ranged from $2.95 to $5.25 each.  So I assume the hospital gets them for AT LEAST that price but probably much better.  But let’s assume the worst case scenario – $400.80 billed to my health plan, of which $5.25 is direct cost, that leaves $395.55.  Of course there is the line from the bag to the IV needle and the needle itself.  I then searched for this item and found what I would think would be a pretty good match – it had the needle, the blood collection port, the injection port, all the cool things I saw on the one they used on me and this was of course pretty expensive – $128.82 on average.  So that leaves Bayfront with a margin of $266.73.

Now there were two other lines right below the IV hydration line:  CPT Code 96374 IV PUSH ONE/FIRS for $341.28 and CPT Code 96375 IV PUSH EA ADDL for $238.02.  I haven’t quite been able to figure those out but it seems that they’re all part of the same treatment family and since there are two of them that would seem to indicate that I would need to add all three items together to get the full cost of my IV hydration treatment.  That brings us to:

$1,380.90

This is where it gets really interesting.  I found a really nice website hosted by the AMA that allows you to lookup CPT codes and what CMS will reimburse for Medicare patients.  I put in these three codes and this is what I got back:

  • 96361 = $14.79
  • 96374 = $54.95
  • 96375 = $21.71

That’s a total of $91.45 – hmmmm.

So Bayfront bills Blue Cross Blue Shield of Massachusetts $1,380.90.  I don’t know what @BCBSMA paid because after only 40 short days I have only received two EOBs from them.  It appears they are going to send me an EOB for each line item individually and I haven’t received this one yet.  Regardless, $1,380.90 – $91.45 is $1,289.45 or FIFTEEN TIMES what Medicare would reimburse for those same codes.

I don’t have a conclusion for this one – as I said, just observations along the way.  If I don’t get all this down and out there my brain is going to explode.  Stay tuned for my craziness.