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Pulmonary Embolism Treatment Cost


How Much Does Pulmonary Embolism Treatment Cost?

 
average costWith Health Insurance: Copay or 10%-50% Coinsurancehigh costWithout 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[1] 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[2] 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[3] , average total per-incident medical costs for pulmonary embolism are about $30,000.
Related articles: Blood Clot Treatment, Emergency Room Visit, Health Insurance

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[4] is administered intravenously to stop more blood clots from forming. Another blood-thinning medication, enoxaparin[5] , might be given by subcutaneous injection. Another medication, warfarin[6] , 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[7] 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[8] .
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[9] or Arixtra[10] -- 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[11] , 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[12] 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[13] in California offers a 35% discount.
  • The manufacturer of the anticoagulant drug Coumadin, Bristol-Myers Squibb, participates in the Together Rx Access[14] 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[15] .
Shopping for pulmonary embolism treatment:
  • The U.S. Department of Health and Human Services offers a hospital comparison tool[16] that lists hospitals near a chosen zip code and whether they offer emergency services.
  • A family doctor and pulmonologist -- a board-certified internal medicine[17] 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[18] by location and specialty. It is important to make sure any specialist you are considering is board-certified[19] .
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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What People Are Paying - Recent Comments
Small Pulmonary Embolism
Amount: $66,700.00
Posted by: Boldiczar K in Mt. Holly, NJ.Posted: June 3rd, 2013 08:06AM
Physician: Medical Center: Virtua Health Mt. Holly NJ
In hospital 7 days, small PE in lung, 1 extra day because they took me off heparin for almost a day before putting another bag on. $66,700 seems way too expensive! That would pay a nurse's salary for a year.
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External Resources:
  1.  www.saintelizabethonline.com/price-estimator-1.html
  2.  www.wipricepoint.org/Basic_INP.aspx
  3.  www.thoracic.org/education/breathing-in-america/resources/chapter-16-pulmonary-embolism...
  4.  www.nlm.nih.gov/medlineplus/druginfo/meds/a682826.html
  5.  www.nlm.nih.gov/medlineplus/druginfo/meds/a601210.html
  6.  www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000634/
  7.  www.medicinenet.com/urokinase-injection/article.htm
  8.  www.emedicinehealth.com/pulmonary_embolism/page4_em.htm
  9.  www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000158/
  10.  healthcare.utah.edu/thrombosis/patients/Arixtra.pdf
  11.  labtestsonline.org/understanding/analytes/pt/tab/test
  12.  www.stoptheclot.org/News/article120.htm
  13.  www.whhs.com/about/washington-hospital-discount-policy-for-uninsured/
  14.  www.bms.com/products/Pages/programs.aspx
  15.  www.lovenox.com/consumer/default.aspx
  16.  www.medicare.gov/hospitalcompare/(S(efntd2saaeir2l5pgarwuvvg))/search.aspx?AspxAutoDete...
  17.  www.abim.org/specialty/pulmonary-disease.aspx
  18.  extapps.ama-assn.org/doctorfinder/disclaimer.do
  19.  /www.certificationmatters.org/is-your-doctor-board-certified/search-now.aspx
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