Pneumonia on a Budget
Saw a guy today with no insurance, plus fever, chills and productive cough. His chest sounded clear and his oxygen wasn't too bad (95% sat on room air) but he looked really crappy, so I sent him for a chest x-ray and gave him a prescription for clarithromycin 500 BID for 10 days. As it happened, the x-ray came back positive for pneumonia with a patchy right upper lobe infiltrate, so I told him to be sure to fill and finish the antibiotic.
How much did the day cost him?
I told him I could easily have buffed the chart to justify a level 3 visit ($70) (or even a 4 for $100) but my usual practice for the uninsured is to bump it down a notch.
My charge: $55.00
Instead of sending him to the hospital for the x-ray, I sent him to a new free-standing radiology facility that charges the uninsured only 10% over what Medicare would pay.
Chest x-ray: $62.00
One of the local supermarkets is running a special on free antibiotics. Unfortunately, the one I wrote for isn't on that list, and they wanted $78 for it. He called CVS and their price was $92. He went to Costco instead.
If my math is right, that comes to $134.00 grand total for medical care for today's diagnosis and treatment of pneumonia. What this demonstrates is that there are options for economical medical care with no sacrifice in quality. (Levaquin, another antibiotic commonly prescribed for outpatient pneumonia, is hideously expensive, typically costing $10-$15 per pill. Not only that, but it isn't even the best choice in terms of antimicrobial coverage for community-aquired pneumonia.) That total also comes to a fraction of what a monthly health insurance premium would cost him.
It just goes to show that even in this day and age of "broken" health care, there are bargains available for the savvy doctors and patients who know where to find them.