Coronavirus Care Costs Vary Widely, Even Within Cities

Costs of typical services for evaluating patients seeking care associated with COVID-19 not only vary dramatically from city to city across the U.S., but also vary widely within the same city, according to an analysis released Friday by Castlight Health, a health navigation platform.

Costs also vary depending on the source of care: a telehealth provider, a primary care doctor, an urgent care clinic or an emergency room.

"While the test for COVID-19 may be made available at no cost, individuals seeking care for suspected COVID-19 may be faced with other significant out-of-pocket costs for that care," Castlight Health's chief executive, Maeve O'Meara, said in a statement.

"Sadly, those bills may be coming right as many Americans are losing their paychecks, creating real affordability of care issues."

Castlight Health evaluated the out-of-pocket cost of care in these cities and their surrounding metropolitan areas: Boston, Chicago, Cleveland, Dallas, the District of Columbia, Houston, Los Angeles, Miami, New York, Salt Lake City, San Francisco and Seattle.

Widely Varying Costs

The analysis found that costs depend on severity of symptoms. In the Seattle metro area, for example, a patient with a fever and a cough but no chest pain who goes to a primary care doctor for an evaluation can expect an average cost of $197.

But if the symptoms include a high fever, cough, chest discomfort and shortness of breath, the doctor will likely order lab tests and a chest x-ray, increasing the cost of a primary care evaluation to an average of $1,001.

The site of care also affects costs, according to the analysis.

Even absent symptoms severe enough to warrant lab testing, a diagnostic evaluation can cost someone living in the New York metro area $0 to $100 for a telehealth visit, $100 to $450 for a primary care visit, $250 to $514 for an urgent care visit and $506 to $4,985 for an emergency room visit.

Costs vary between markets. In Seattle, the cost of an evaluation involving a primary care visit, a standard set of lab tests and a chest x-ray will average $1,001, in San Francisco $2,493 and in Miami $3,153.

Costs also vary within markets. Here are the ranges for a primary care visit and standard lab testing within three cities:

Los Angeles, from $304 to $4,447 — roughly a 14-fold difference
Miami, $354 to $5,729 — a 16-fold difference
Dallas, from $193 to $4,308 — a 22-fold difference

Out-of-Pocket Expenses

The coronavirus relief measures signed by President Donald Trump in the Families First Coronavirus Response Act direct private health plans to waive the cost of the specific coronavirus test and visit associated with it.

Still, people who are symptomatic and seek care may be responsible for other costs required for an evaluation for COVID-19, according to Castlight.

It noted that these could include influenza testing, chest x-rays and bacterial, viral or blood culture tests. Such costs can mount quickly, particularly for the 27.5 million people with no insurance or those who have high-deductible health plans and will pay for services out of pocket.

The severity of COVID-19 symptoms varies widely, from mild cough and fever, to chest pains and shortness of breath, which can drastically affect the necessary treatment, need for hospitalization and associated costs.

"During this incredibly stressful pandemic outbreak, it is critical that people have a clear understanding of the care they need, and how much that care is likely to cost," Dena Bravata, a Castlight advisor, physician and former senior scholar at the Stanford Center for Primary Care and Outcomes Research, said in the statement.

The Analysis

Castlight's primary source of data for the analysis was a subset of 2.5 billion de-identified medical claims for primary care, urgent care, emergency room, lab tests and x-ray, supplemented with provider directory data (such as which doctors provide which types of care), provider rate sheets and publicly available data.

The costs indicated are for a member in his or her deductible phase seeing in-network providers. The ranges provided are for the fifth to the 95th percentile of costs in that metropolitan region.

The components of an evaluation for patients seeking care associated with COVID-19 depend on their symptom severity and site of care. Castlight included these procedures and services: site of care, care for moderate coronavirus symptoms and care for severe symptoms.

— Check out What if COVID-19 Keeps Clients From Working? on ThinkAdvisor.