Hospitals bill insurers more than $300,000 per complex COVID-19 patient, new data show

Hospitals bill insurers more than $300,000 for complex COVID-19 cases, which is three times more than the rate they negotiate, according to new data.

Complex COVID-19 cases, which can involve ventilation, transfusions, intensive care, among other equipment, tests and services, yield a $98,139 negotiated rate on average, new cost estimates from FAIR Health found. That compares to a $33,525 negotiated rate—including patient cost-sharing—for general COVID-19 hospitalizations and $1,008 for non-COVID-19 hospital stays.

While the gross charges have little bearing on the actual cost or quality of the care, uninsured and out-of-network patients may reap the full charges.

"There is a heightened level of interest of healthcare stakeholders and the media on the cost of care for COVID-19—both inpatient and outpatient," FAIR Health President Robin Gelburd told Modern Healthcare.

FAIR Health data are based on a 12-month window of medical claims from its database of around 35 billion medical and dental claims. While the negotiated rates vary by hospital and region, the not-for-profit research group has not reported those metrics yet, Gelburd said, noting that FAIR Health will come out with state-level cost variation data next month.

The unvaccinated account for a vast majority—about 98%—of all COVID-19 hospitalizations since June, according to the Kaiser Family Foundation. It cost about $5.7 billion to treat around 287,000 unvaccinated Americans who were hospitalized from June through August, KFF data show.

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