FORT COLLINS, Colo. — When Lindsey Messinger had to spend the night in Poudre Valley Hospital earlier this year, the last thing she was worried about was the cost — until she saw that cost.
One line item in particular stood out: the UCHealth charge for a pneumonia vaccine a nurse had recommended.
"I thought maybe someone entered that in wrong," Messinger said. "Maybe there's an extra digit that there shouldn't be. Between the vaccine and the administration cost, it was $4,400."
Messinger's records show her insurance would cover some of that cost, but not all. She would be responsible for about $700.
"I can see paying more for something at a hospital — maybe double, triple, quadruple, maybe. But this was 14 times what I would have paid getting this vaccine at my pharmacy."
Emily Zadvorny with the Colorado Pharmacists Society confirmed that typically, the same vaccine would cost a few hundred dollars in a pharmacy if a patient had to pay anything.
"Typically, you know, patients usually have insurance coverage for vaccinations in a pharmacy," said Zadvorny. "The fact she got [the vaccine] was the appropriate care. The unfortunate part is the vast difference in pricing that can happen based on your setting of care."
At the federal level, bipartisan solutions are being proposed in the Lower Costs More Transparency Act, which passed in the House of Representatives.
Consumer advocates with Families USA, a nonprofit focused on affordable healthcare, argue that something has to change to protect consumers from billing surprises and provide price transparency.
"If you're getting a vaccine, or if you're getting an MRI, it should be the same price. It should be the same price regardless of where you get the service. And so those are some of the solutions that are being debated right now in Congress," said Sophia Tripoli with Families USA.
Messinger said when she complained about the vaccine cost, UCHealth reviewed her bill twice and found it to be accurate. In a statement to Denver7, a UCHealth spokesperson wrote, in part, that generally the price for services is "dependent on the negotiated rate between the insurance provider and the health care organization."
"Staff and providers at UCHealth strive to provide the best care for patients each and every day. Care recommendations are based on the information they have access to at the time the patient arrives at one of our facilities.
"We encourage patients who have concerns about their bill to reach out to our billing customer service team, who will look into their concerns. If the information they are receiving is unclear, they should ask to have their concerns escalated to a manager. We also encourage patients who have concerns or questions about their care to contact our patient representatives.
"While we cannot discuss any individual patient without a signed consent, generally speaking, the reimbursed amount for a particular service is dependent on the negotiated rate between the insurance provider and the health care organization. A patient’s actual bill is dependent on their insurance plan and individual circumstances including how much of their deductible they have met during their current plan year."
But on Wednesday, Messinger received a call from the hospital. She said a UCHealth representative told her that her statement was being reviewed and "administratively adjusted" so her $700 co-pay would be removed.
"I think that's great for me," said Messinger. "But what about other people? And why did I have to escalate this so far to get a response?"
