 | With Health Insurance: Copay or 10%-50% Coinsurance |
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 | Without Health Insurance: $15,000-$40,000+ |
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| A pulmonary embolism is a blockage of an artery in the lungs, often caused by a blood clot that has come from another part of the body, such as the legs. A pulmonary embolism can be fatal, so it is necessary to seek emergency care immediately. | | |
| Typical costs: | - For patients covered by health insurance, out-of-pocket costs for a pulmonary embolism typically would include a copay or coinsurance of 10%-50%, prescription drug copays, follow-up doctor visit copays and laboratory copays. Health insurance typically covers treatment for a pulmonary embolism.
- For patients not covered by health insurance, treatment for a pulmonary embolism typically costs $15,000 -$40,000 or more, depending on the length of hospital stay and whether there are complications. For example, Saint Elizabeth Regional Medical Center in Nebraska charges $12,500 -$29,500 for treatment for a pulmonary embolism without major complications, depending on the individual case and length of stay, not including doctor fees. St. Mary's Hospital in Wisconsin charges about $15,000. And Baptist Memorial Health Care in Tennessee charges about $20,500 without major complications and about $37,000 with major complications, not including doctor fees. According to the American Thoracic Society, average total per-incident medical costs for pulmonary embolism are about $30,000.
What should be included: | - First, doctors will work to stabilize the patient and confirm diagnosis. Initial treatment might include placing the patient on a heart monitor and administering oxygen and medication to raise blood pressure.
- Typically, the blood-thinning medication heparin is administered intravenously to stop more blood clots from forming. Another blood-thinning medication, enoxaparin, might be given by subcutaneous injection. Another medication, warfarin, typically is given orally. It usually takes a few days for warfarin levels to reach an appropriate therapeutic dose. In cases in which a patient is severely ill and not responding to treatment, a drug such as urokinase might be given by injection to break up existing clots. The required hospital stay can range from two to three days to a week or longer.
- eMedicineHealth.com offers an overview of pulmonary embolism treatment.
Additional costs: | - After discharge from the hospital, the patient typically will be placed on an anti-coagulant drug -- typically warfarin (brand name Coumadin) to help prevent blood clots. For a one-month supply, Drugstore.com charges about $15 -$25 for the generic and $50 -$70 for the brand name drug.
- Lovenox or Arixtra -- both injectable anti-coagulant drugs -- might be prescribed temporarily, along with warfarin, until the warfarin reaches therapeutic levels in the blood. Drugstore.com charges more than $700 for a one-month supply of Lovenox and $1,600 or more for a one-month supply of Arixtra. Insurance often covers these drugs when medically necessary, such as for patients who cannot take warfarin.
- Patients on anti-coagulant drugs require regular monitoring -- for example, for warfarin a PT (prothrombin time)/INR (international normalized ratio) test, as frequently as once per week, to make sure the drugs are working effectively. This typically costs $6 -$25 per test at a doctor's office or laboratory, or can be done as a home test with the purchase of tests strips and a machine that costs $1,500 -$2,500.
- Depending on the individual case, and if there is an underlying condition -- such as cancer or heart disease -- or recurrent pulmonary embolism, the patient might require extensive follow-up care and monitoring that could cost thousands, or tens of thousands, of dollars.
Discounts: | - Many hospitals give discounts of up to 30% or more to uninsured/cash-paying patients. For example, Washington Hospital Healthcare System in California offers a 35% discount.
- The manufacturer of the anticoagulant drug Coumadin, Bristol-Myers Squibb, participates in the Together Rx Access program, which offers discounts of 25%-40% on certain drugs. The manufacturer of Lovenox, Sanofi-Aventis, offers the drug for free to uninsured patients who qualify on a case-by-case basis, through its patient reimbursement program.
Shopping for pulmonary embolism treatment: | - The U.S. Department of Health and Human Services offers a hospital comparison tool that lists hospitals near a chosen zip code and whether they offer emergency services.
- A family doctor and pulmonologist -- a board-certified internal medicine doctor with additional training in lung diseases -- can provide follow-up care. Depending on the individual case, and whether there was an underlying cause, such as cancer, for the pulmonary embolism -- other specialists might be needed for ongoing care. These could include a hematologist -- a board-certified internal medicine doctor with additional training in blood disorders -- or an oncologist, cardiologist or thoracic surgeon.
- The American Medical Association offers a doctor finder by location and specialty. It is important to make sure any specialist you are considering is board-certified.
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Material on this page is for informational purposes only and should not be construed as medical advice. Always consult your physician or pharmacist regarding medications or medical procedures.
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Article updated February 2012 |
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