COVID-19 Claims Data Reveal Real-World Tx Costs


Median “charge amounts” for hospital treatment of COVID-19 — the sticker price for patients without insurance or receiving out-of-network care — ranged from about $35,000 for those age 23-40 to $46,000 for individuals in their 50s, according to a report released Tuesday by FAIR Health, based on payer data covering more than 150 million Americans.

So-called allowed amounts — the total estimated to be paid by patients and their insurers — were lower, however. These ranged from just over $17,000 for patients older than 70 (in this analysis, primarily Medicare Advantage enrollees) to about $24,000 for those ages 51-60.

The report (which also detailed other characteristics of COVID-19 patients, including the prevalence of comorbidities stratified by age and geography, as well as use of telehealth services) revealed considerable geographic variation in median charges as well.

In fact, very low charge amounts for patients older than 70 in the Northeast skewed the national-level figures. In the rest of the country, the over-70 group had the highest charge amounts of any age stratum — as high as $93,459 in the West — yet the national median of $37,109 for this group was the second lowest of the report’s eight age groups.

FAIR Health analyzed private insurer data from 31 billion claim records from more than 60 payors and third-party administrators, concerning more than 150 million people, including those on Medicare Advantage. The analysis focused on records featuring COVID diagnostic codes: U07.1, 2019-nCoV acute respiratory disease; and B97.29, “other coronavirus as the cause of diseases classified elsewhere.”

The analysis included claims from Jan. 1 to June 30, with dates of services through mid-May. FAIR Health said its data set of private insurer claims is the largest anywhere, covering 75% of the total market. However, the analysis did not include patients enrolled in original Medicare, Medicaid, CHIP, or state and local programs.

  • Ryan Basen reports for MedPage’s enterprise & investigative team. He has worked as a journalist for more than a decade, earning national and state honors for his investigative work. He often writes about issues concerning the practice and business of medicine. Follow

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