The case of the $629 Band-Aid — and what it reveals about American health care
Vox
By Sarah Kliff
May 13, 2016

Last January, Malcolm Bird took his 1-year-old daughter, Colette, to the local emergency room. His wife had accidentally cut the young girl’s pinky finger while clipping her fingernails, and it had begun to bleed. They were nervous, first-time parents who wanted a doctor’s opinion.

Colette turned out to be completely fine. A doctor ran her finger under the tap, stuck a Band-Aid on her pinky, and sent the family home.

A week later, something else showed up at home: a $629 hospital bill for the Band-Aid and its placement on Colette’s finger.

His insurance had negotiated the price down to $440.30, the amount Bird — who was still in his deductible — was expected to pay.

“My first thought was, how could this possibly cost $629?” Bird told me when we spoke in April. “So I wrote the hospital a letter, expecting them to say, yeah, that’s a bit excessive, and lower the price.”

That didn’t happen. The hospital sent him back a long letter explaining why it would stick with the price. The fees, the hospital’s leadership responded, were justified — and it ultimately sent his unpaid bill to a debt collection agency.

Bird sent me all his correspondence with the hospital, which I ran by medical billing experts. His experience provides a unique window into how emergency health care billing works in the United States, and how easy it is for customers to end with a surprise bill for a relatively small service — like a Band-Aid on a child’s finger.

“5 minutes, water, gauze, and a band aid, is that really $629?”
Here’s what happened when Colette went to the emergency department, as recounted by her father, Malcolm.

They showed up and waited about 20 minutes until they were called back and placed into an exam room. A nurse came by and checked on them, and a few minutes later a doctor came in.

“He tells us that Colette is okay, that the reason it’s bleeding so much is because there are so many capillaries at the end of the finger,” Bird said. “Then he literally runs the finger under the tap, dries it, puts a Band-Aid on it, and says that’s it. We’re very relieved, we go back to the car, and the Band-Aid falls off. But it was fine because it had stopped bleeding.”

Everything about the visit, he says, seemed fine — the doctor, the nurse, all of them were reassuring and provided appropriate care.

Then the $629 charge arrived. To Bird, this seems nuts — in his view, the hospital wanted him to pay $629 for a Band-Aid. Even though his insurance had negotiated the price down to $440, he was still incensed by that initial number.

“I’m not saying you shouldn’t make a profit … but 5 minutes, water, gauze, and a band aid, is that really $629?” he wrote in a July letter to the hospital.

About two weeks later, the hospital’s chief executive responded — yes, it was.

This was John Murphy, who is the chief executive of the Western Connecticut Health Network, which owns the hospital where Colette was seen. He wrote back to share “a different perspective” on the emergency bill.

First, he points out that the Band-Aid didn’t cost $629; it was actually just $7. The other $622 was the cost of seeing the doctor and using the emergency department itself.

Here, Murphy touches on an important concept in emergency department billing — the part that explains how bills for ER visits can be so high.

“The remainder of the charge,” he writes, “was associated with the use of the facility and staff. We staff the emergency department 24-hours a day, every day of the year, and stand ready to treat whoever walks through our door, be it a gunshot victim or a patient with a stroke.”

Murphy is explaining something called a “facility fee,” the base price of setting foot inside an emergency room. It’s something akin to the cover charge you’d pay for going out to a nightclub.

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