Anatomy of a Medical Bill

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Anyone who’s ever sought medical attention knows that the hospital experience isn’t necessarily over once you’re discharged. The bill for your care can often raise more questions than it answers, especially when you take into account some of the factors involved — negotiated rates between hospitals and insurance companies; the fluctuating cost of services from one geographical area to the next. To get a broad view of why hospitals charge what they do (and what all that medical-bill jargon actually means) we asked Peter Smulowitz — an attending physician in Beth Israel’s department of emergency medicine and a Harvard Medical School instructor — to break down this real-life statement from a visit to Norwood Hospital’s emergency room.

CAT SCAN BODY  $2,752.00
How does the charge for this common procedure break down? It covers the use of the CT, any contrast (dye) required for the study, and the time of both the radiology technician and the radiologist who reads the CAT scan.

DRUG SPEC ID DETAIL CODING  $474.00
This line likely refers to medication delivered to the ER — like morphine for pain, or an antibiotic.

ER GENERAL  $623.00
You’ll see “ER General” on the bill any time you visit an emergency room, regardless of the problem. “If someone comes in with a sore throat, has no testing done, and receives a prescription for an antibiotic, there may be no charge aside from this.”

LABORATORY GENERAL  $446.00
Basically, this is what you’ll see for any lab work that’s done — a complete blood count or electrolyte panel, for instance.

M/S SUPPLY STERILE SUPPLY  $89.00
You’ll find this charge for any extra supplies used in the ER, such as IV tubing and gauze.

INSURANCE DISCOUNTS  -$476.10
“While every insurer gets the same charge on their bill, there is then a listed discount, depending on the contract between the hospital and that particular insurance company.” This factors into how much you’re going to end up paying out of pocket.

INSURANCE PAYMENTS  -$1,973.96

THE VERDICT  $1,933.94
“You are seeing some pretty standard charges from the ER for a CAT scan, medications, [and] laboratory tests.”

The hospital declined to talk with Boston, noting that due to disparities in healthcare coverage and insurance discounts, there is no such thing as a typical bill.