Who knows whether it was the stuffing, cranberry sauce, or that vegetable casserole, but something at Thanksgiving dinner didn’t sit right with Evan Acuna.
Two days after the big feast he was still feeling the effects of what the 27-year-old suspected was food poisoning. When he couldn’t even keep down water and started to get delirious from dehydration, Acuna’s girlfriend took him to Capital Health-Hopewell, outside Trenton.
In the hospital’s emergency department, Acuna received two IVs of fluids and within a couple hours was feeling better and sent on his way.
It seemed to be a minor medical episode, as far as ER visits go. But when he got the bill a month later, Acuna realized how wrong he was: This was a $9,200 tummy ache.
Acuna’s Cigna health plan negotiated a lower rate of $7,870 and paid $3,117. Acuna was responsible for $4,752 because he had not yet met his plan’s $5,000 deductible.
“I was just almost in tears,” said Acuna, of Collingswood. “I can’t pay this. I’ve never in my life had a bill I couldn’t pay.”
Emergency departments are notoriously expensive because they must be prepared to respond to a wide range of scenarios on the spot, around the clock, which enables them to charge more than clinics or urgent-care centers and pricey fees just for walking in the door. The bills can be especially shocking for young adults, such as Acuna, newly paying for their own care with limited savings.
What adds to the frustration and confusion is how arbitrary hospital pricing can be.
In a fit of panic and outrage, Acuna called the hospital the day after he got the bill and said there was no way he could pay it. The hospital agreed to reduce his portion to $779.
Acuna was relieved but stunned anew: If $779 was an acceptable payment, why had he been charged almost six times as much?
“A squeaky wheel gets a cheaper rate — that’s what it comes down to,” said Ellen Magenheim, president of We Care Advocates in Cherry Hill, which helps patients challenge medical bills.
“They’d rather take some of it than risk losing all the money, and that’s what bothers me is why there’s such a difference in what they charge and what they’ll accept,” she said.
One reason emergency department bills can be so expensive is because of facility fees that ERs charge just for walking in the door. The sicker you are, the bigger the fee. Acuna was designated a level 4 out of 5 acuity, which came with a $6,100 facility fee. Patients being treated for dehydration who require IV fluids fall under level 4, according to guidelines from the American College of Emergency Physicians.