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 |  | With Health Insurance: Copay or 10%-50% Coinsurance |  | 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[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
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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] .
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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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What People Are Paying - Recent Comments |
| 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: | - www.saintelizabethonline.com/price-estimator-1.html
- www.wipricepoint.org/Basic_INP.aspx
- www.thoracic.org/education/breathing-in-america/resources/chapter-16-pulmonary-emb...
- www.nlm.nih.gov/medlineplus/druginfo/meds/a682826.html
- www.nlm.nih.gov/medlineplus/druginfo/meds/a601210.html
- www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000634/
- www.medicinenet.com/urokinase-injection/article.htm
- www.emedicinehealth.com/pulmonary_embolism/page4_em.htm
- www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000158/
- healthcare.utah.edu/thrombosis/patients/Arixtra.pdf
- labtestsonline.org/understanding/analytes/pt/tab/test
- www.stoptheclot.org/News/article120.htm
- www.whhs.com/about/washington-hospital-discount-policy-for-uninsured/
- www.bms.com/products/Pages/programs.aspx
- www.lovenox.com/consumer/default.aspx
- www.medicare.gov/hospitalcompare/(S(efntd2saaeir2l5pgarwuvvg))/search.aspx?AspxAut...
- www.abim.org/specialty/pulmonary-disease.aspx
- extapps.ama-assn.org/doctorfinder/disclaimer.do
- /www.certificationmatters.org/is-your-doctor-board-certified/search-now.aspx
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