An investigation by the Center for Public Integrity found that between 20 the number of Level 4 and 5 visits for patients who were sent home from the ER nearly doubled to almost 50% of visits. After all, the insurer isn’t in the exam room to know what transpired. Emergency room visits are coded from Level 1 to Level 5, with each higher level garnering more generous reimbursement, in theory commensurate with the work required.īut over the past 20 years, hospitals and doctors have learned there’s great profit in upcoding visits. Renee Hsia, a professor of emergency medicine and health policy at the University of California-San Francisco and a practicing ER doctor, said Level 5 charges are supposed to be reserved for serious cases - “a severe threat to life, or very complicated, resource-intense cases” - not for patients who can walk through a hospital on their own. It is the biggest item on the bill other than the delivery itself.ĭr. Was it for checking in at the ER desk, as she’d been instructed to? She recalls going through security there on her way to labor and delivery, yet there was a $2,755 charge for “Level 5” emergency department services - as if she had received care there like a patient with a heart attack or fresh from a car wreck. The total bill was huge, but what really made Wells Salerno’s eyes pop was a line for the highest level of emergency services. What Gives: In a system that has evolved to bill for anything and everything, a quick exam to evaluate labor in a small triage room can generate substantial charges. Service Provider: Poudre Valley Hospital in Fort Collins, Colorado, operated by UCHealth, a nonprofit health system. Insurance paid $10,940.91 and the family paid the remaining $3,609.09 to the hospital. The Anthem BCBS negotiated rate was $14,550. Medical Service: A routine vaginal delivery of a full-term infant. She is insured by Anthem Blue Cross Blue Shield through her job. The Patient: Caitlin Wells Salerno, a conservation biologist at Colorado State University and a principal investigator at Rocky Mountain Biological Laboratory. They were braced to pay more for Gus… but how much more? She was a postdoctoral fellow in California with top-notch insurance when Hank was born, about four years earlier. Wells Salerno expected the bill for Gus’ birth to be heftier than that for her first child, Hank, which had cost the family a mere $30. Their medical bill later included a $2,755 charge for ‘Level 5’ emergency services. When Caitlin Wells Salerno went into labor in April 2020, she and husband Jon were told to go through a Fort Collins, Colorado, hospital’s emergency room doors because it was the only entrance open. Gus was born a healthy 10 pounds after about nine hours of labor, and the family went home the next morning. “I was just thrilled that he was here and it was on his due date, so we didn’t have to have an induction,” she said. She even took a selfie, smiling, as she entered the delivery room. Wells Salerno felt well enough to decline the help of a nurse offering to wheel her to the labor and delivery department. She and her husband, Jon Salerno, were instructed to go through the emergency room doors at Poudre Valley Hospital in Fort Collins, Colorado, because it was the only entrance open.ĭespite the weird COVID vibe - the emptiness, the quiet - everything went smoothly. Wells Salerno went into labor on the eve of her due date, in the early weeks of coronavirus lockdowns in April 2020. That didn’t prepare her for the resources the conservation biologist would owe after the birth of her second son. This article is excerpted from a story by Rae Ellen Bichell appeared on Kaiser Health News (KHN) on October 27, 2021.Ĭaitlin Wells Salerno knew that some mammals - like the golden-mantled ground squirrels she studies in the Rocky Mountains - invest an insane amount of resources in their young.