The Real Costs of Seeking Care for COVID-19 Vary Across and Within Major U.S. Cities
Mar 20, 2020
Castlight Health’s COVID-19 Cost Analysis Finds Outpatient Evaluation Costs Vary Widely Depending on Severity of Symptoms, Geography, and Provider Type
SAN FRANCISCO, March 20, 2020 — Castlight Health, Inc. (NYSE: CSLT) today released a COVID-19 Cost Analysis, which presents the costs of typical services for evaluating patients seeking care associated with the novel coronavirus, COVID-19. The analysis finds that costs not only vary dramatically from city to city nationwide, but also vary widely within the same city. Costs also vary depending on the source of care, whether it is a telehealth provider, a primary care doctor, an urgent care clinic, or the 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. Sadly, those bills may be coming right as many Americans are losing their paychecks, creating real affordability of care issues,” said Maeve O’Meara, CEO of Castlight Health. “Costs vary widely across cities in the U.S., within cities, and depending on the site of care. During this public health emergency, it is more important than ever that people have the tools they need to find high quality care in a timely and affordable manner.”
Although the coronavirus relief measures signed by the President in the Families First Coronavirus Response Act have directed private health plans to waive the cost of the specific coronavirus test and visit associated with it, people who are symptomatic and seek care may be responsible for other costs required for an evaluation for COVID-19. These could include influenza testing, chest x-rays, and bacterial, viral, or blood culture tests. These costs can add up 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 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.
Most notably, the analysis found that:
Within a given U.S. city, average prices vary greatly for patients exhibiting standard COVID-19 symptoms including fever, cough, and shortness of breath:
- In Los Angeles, the cost for a primary care visit and standard lab testing ranges from $304 to $4447—roughly a 14-fold difference.
- In Dallas, the cost for the same services ranges from $193 to $4308—a 22-fold difference.
- Similarly, in Miami, these services range in cost from $354 to $5729—a 16-fold difference.
Costs also vary widely depending on the provider type or site of care:
- Even without symptoms severe enough to warrant further imaging or lab testing, a visit to evaluate respiratory symptoms can cost someone living in the New York metro area an average of $79 for a telehealth visit, $235 for a primary care visit, $352 for an urgent care visit, and $2,321 for an ER visit.
- In Miami, patients can expect costs for evaluating symptoms to average $79 for using telehealth as their entry point, $189 for visits through a primary care provider, $483 for visits through an urgent care provider, and $1,524 if they enter the system through the ER.
“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,” said Dena Bravata, MD, MS, Castlight Advisor and former Senior Scholar at the Stanford Center for Primary Care and Outcomes Research. “Castlight’s COVID-19 Cost Analysis sheds light on the vastly different costs patients seeking care associated with COVID-19 will see depending on where they live, and where they choose to receive care.”
The primary source of data used for this analysis is 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 (e.g., which doctors provide which type of care).
- Provider rate sheets.
- Publicly available data.
The costs provided are for a member in their deductible phase seeing in-network providers. The ranges provided are for the 5th to the 95th percentile of costs in that metropolitan region.
The components of an evaluation for a patient seeking care associated with COVID-19 depend on their symptom severity and site of care. The procedures and services we included are:
- Site of care: telehealth visit, primary care visit, urgent care visit, ER visit.
- Care for moderate COVID-19 symptoms: initial cost of a provider visit, influenza test, sputum culture and sensitivity, blood culture and sensitivity, complete blood count, and comprehensive metabolic panel.
- Care for severe COVID-19 symptoms: initial cost of a provider visit, all lab tests listed above, and a chest x-ray.
Click here to download the full report.
About Castlight Health
Castlight is on a mission to make it as easy as humanly possible for its users to navigate the healthcare system and live happier, healthier, more productive lives. Our health navigation platform connects hundreds of health vendors, benefits resources, and plan designs into one comprehensive health and wellbeing experience. We guide individuals—based on their unique profile—to the best resources available to them, whether they are healthy, chronically ill, or actively seeking medical care. Castlight transforms the employee benefit experience into a deeply personalized, yet simple, guided one, empowering better-informed patient decisions to unlock better healthcare outcomes and maximizing return on healthcare investments.
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