Costly care - a $1,500 ER visit

Nancy and Larry Lubas, with son Michael, 15, in the middle, with the stack of bills and correspondence regarding Michael's brief, 20-minute visit to an emergency room for a jammed finger, which resulted in $2,200 in medical expenses. (Clem Murray / Staff Photographer)

Like most parents, I would do whatever it takes if one of my children is hurt. Certainly that would include – and has included – rushing to the ER without a thought about the cost.

Still, a story by my colleague Don Sapatkin in the Health & Science section on Monday April 12 is enough to give you pause.

In February, 15-year-old Michael Lubas hurt a finger playing flag football and the 30-minute ER visit to have it checked out cost $1,500. That wasn’t the bill, but the actual amount the Lubas’ health plan – a health reimbursement account that the family pays into – actually spent.

The cost – more than ten times what it would have cost at a nearby urgent care clinic – stunned Lubas’ mother and infuriated his father, who says it took a huge bite out of the money his employer contributed to the HRA – money that could have been rolled over to next year and thereby reduced the family’s out of pocket health spending.

Here’s an excerpt of the story:

Larry Lubas’ plan, called a Health Reimbursement Account, is typical of policies spawned by the movement known as consumer-driven health care. His CIGNA policy, which he chose over a traditional Aetna plan two years ago “to better manage my expenses,” has a whopping $4,800 annual deductible for the family. But his employer puts $2,400 into the account to reimburse all deductibles up to that amount.

Lubas, who works as a multi-line insurance agent for Prudential, which does not sell health insurance, has some control over the HRA money by picking where he goes for health care. If money is left at the end of the year, some can be rolled over. If he uses it up, however, he is fully responsible for the next $2,400 in deductibles, after which his insurance pays 90 percent for in-network providers.

Because there was money in the account when his son went to the ER, Lubas paid nothing for the ER visit. On the other hand, he said, “I will probably by June use up all of my $2,400, so my next six months are on me.”

He was furious at the hospital: “Emergency rooms are cleaning up, they are making a ton of money off of people like me and my insurance.”

The reality is a little different according to experts. Still, that leaves a legitimate question for most of us: how is a parent, or anyone else, supposed to know when to go to an expensive ER verse an urgent care center or even wait until your doctor’s office is open.

Read the full story on Monday in The Inquirer.