First, he points out that the Band-Aid didn't cost $629; it was actually just $7. The other $622 was the cost of seeing the doctor and using the emergency department itself.
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"The remainder of the charge," he writes, "was associated with the use of the facility and staff. We staff the emergency department 24-hours a day, every day of the year, and stand ready to treat whoever walks through our door, be it a gunshot victim or a patient with a stroke."
Murphy is explaining something called a "facility fee," the base price of setting foot inside an emergency room. It's something akin to the cover charge you'd pay for going out to a nightclub.
"It's the fixed price, and that's just what you're going to have to pay," says Renee Hsia, a professor at University of California San Francisco who studies emergency billing.
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Hsia says the thing that infuriates her is how common bills like this are; she sees them all the time. The amount is almost impossible to predict, because facility fees vary widely and hospitals rarely make the numbers public. One of her studies on ER bills for common procedures showed that prices can vary from as little to $15 to as much as $17,797. And a lot of that depends on the given hospital's facility fees.
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"Facility fees are very arbitrary," she says. "There doesn't seem to be any rhyme or reason to it, which can be really frustrating. There are some places where the basic facility fee can be over $1,000."
I asked the communications department at Western Connecticut Health Network to explain to me how facility fees are set at Danbury Hospital, where Colette was seen. Do they count up the number of new purchases they'd need plus the cost of physician salaries, and come up with a number? Did they look at historical trends about how many patients they might see?
Western Connecticut Health Network never answered my question. Instead, four days after my inquiry, they reversed Bird's bill entirely...
