When Cathy Folkers arrived at the hospital this past April, she was not expecting a three-month stay, let alone a stay that cost more than $1 million.
The 57-year-old Cedar Rapids resident rode an ambulance to the emergency room after a fall broke five of her ribs. But even after she was sent home, something didn’t feel right.
She went back to UnityPoint Health-St. Luke’s Hospital the next day, April 26, and was admitted after doctors discovered a punctured lung. They also tested her for COVID-19.
Her COVID-19 test came back positive. Folkers’ health deteriorated quickly after that.
Folkers, who was unvaccinated, spent the next 89 days in and out of the intensive care unit, which included three weeks on a ventilator to help her breathe. When Folkers was placed in a medically induced coma to go onto the ventilator in early May, doctors told her family there was only a 1-in-8 chance she would be taken off, her son Chad Folkers recalled.
But Folkers did improve, and she was discharged on July 23.
Today, Folkers has more than 400 pages of statements and other documents from her nearly three-month hospital stay — one of the only ways she can piece together the time for which she has little memory.
During that period, Folkers and her family didn’t think about the cost of her treatment, and it wasn’t until the medical bills arrived that her family began to grapple with the financial impact of her illness.
The bill for her 89-day hospital stay? $1,028,333.91.
The cost was covered entirely by Medicaid — a fact Folkers said she is thankful for. She lives in affordable housing in Cedar Rapids, and relies on Social Security checks each month to get by.
“I don’t know what I would have done,” Folkers said.
But the financial implications of the disease go far beyond the hospitalization rates. For patients, their recovery costs also can entail prescriptions, occupational and physical therapy, and other continued medical care.
The time taken off from work, both for themselves and their loved ones caring for them, also plays a role when considering the financial toll on families.
Folkers recently received notice she would be deducted $1,600 overpaid to her from her Supplemental Security Income because of a policy that states if an individual enters a hospital or other medical facility, benefits are reduced to $30 a month. She typically receives $840 a month.
Even with some financial assistance from her son, Folkers had to borrow $1,000 to cover her monthly bills, including rent and utilities
“Somehow I’ll get through,” Folkers said. “It’s kind of a robbing-Peter-to-pay-Paul type of thing, but I mean, I just do what I have to do.”
The pandemic is drawing close to its third year, as of this March, and coronavirus infections continue to send Iowans to the hospital. The omicron variant has driven new cases to the highest ever weekly total since March 2020 as of this past week, and hospitalizations reached more than 1,000 admissions statewide.
With Iowans continuing to fall ill to this virus, health care systems statewide still are trying to gain an understanding of what the financial toll will be.
What is the cost of COVID-19?
Approximately 1,600 inpatients were discharged from St. Luke’s in Cedar Rapids with a COVID-19 diagnosis in 2020 and 2021. According to hospital officials, the average cost per discharge was about $15,000.
Individual patient care can vary widely, depending on the severity of someone’s illness, the length of stay and the treatment provided during that stay.
On the low end of the range, the cost of treatment at St. Luke’s was about $1,000 for those who had a short hospital stay — including those who died shortly after admission or those who improved quickly.
For others with prolonged hospital stays, costs have exceeded $250,000, St. Luke’s officials told The Gazette.
The most critically ill patients may require a ventilator, the cost of which varies depending on the length of time on the life-support machine. At St. Luke’s, those costs have varied from $1,000 to $30,000 in 2020 and 2021, officials said.
The state declined to provide any data it may have on the cost of COVID-19 hospitalization for Iowa’s hospitals. State officials also did not respond to requests for reimbursement data from the state-run Medicaid program.
Wellmark Blue Cross Blue Shield, the state’s largest insurance company, also did not immediately respond to requests for data.
Tracking these costs is left to individual hospitals and health care systems, according to the Iowa Hospital Association.
But an outside report may unveil Iowa-specific costs during the first months of the pandemic. FAIR Health, a New York City-based not-for-profit that tracks health care costs nationwide, analyzed data from January to May 2020 on the charge uninsured or out-of-network patients would face as a result of COVID-19 hospitalization.
For a complex patient who is admitted into intensive care and placed on a ventilator, the average charge was more than $278,000, the analysis shows. The average charge was about $51,600 for noncomplex patients — those individuals who are hospitalized but don’t require ventilator or other critical care.
Nationwide, the average COVID-19 hospitalization cost per patient seems to hover around $20,000, according to various sources.
One report from the federal Centers for Medicare and Medicaid Services, or CMS, analyzing data on Medicare beneficiaries found the average COVID-19 hospitalization cost was $24,033. The claims data calculated the cost from more than 1.14 million total hospitalizations from Jan. 2020 until March 2021.
Another study using CMS data reported the average hospitalization cost was $21,752, for a typical stay of about nine days.
According to the study, which was published in the Annals of Internal Medicine in August, the cost increased if the patient needed a ventilator, reaching about $49,000 for an average stay of about 17 days. For those who died, it was about $32,000 for an average length of stay of 11 days.
The study also noted individuals of color incurred higher medical costs than white patients, and that Black and Hispanic patients “accounted for disproportionately high numbers of hospitalizations requiring ventilator support and inpatient deaths.“
One year into the pandemic, Medicare payments for fee-for-service COVID-19 hospitalizations totaled to $16.6 billion, according to the CMS report.
Experts have found the vaccines are effective in preventing serious disease — therefore playing an important role in the potential medical expenses of an infected individual. As the pandemic progresses and the coronavirus continues to spread throughout communities, researchers have begun to study what financial toll unvaccinated patients has had on total COVID-19 costs.
A brief published by the Peterson Center on Healthcare and the Kaiser Family Foundation estimated that more than 690,000 COVID-19 hospitalizations could have been prevented by the vaccines between June and November 2021.
These hospitalizations resulted in $13.8 billion in preventable COVID-19 costs, the brief states.
“At the end of the day, it’s viewed as a driver of cost. It’s a volatile issue, but it’s a reality,” Tim Charles, president and CEO of Mercy Medical Center in Cedar Rapids, said in an interview with The Gazette.
This Iowan’s COVID medical bill: Over $1 million
Cedar Rapids resident Cathy Folkers was hospitalized for 89 days with COVID-19, moving in and out of the intensive care unit. The cost of her stay? More than $1 million. Fortunately for her the cost was covered entirely by Medicaid
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