NEW YORK, March 25, 2020 /PRNewswire/ -- The total costs for all hospitalized COVID-19 patients may range from a low of $362 billion in charges and $139 billion in estimated in-network amounts to a high of $1.449 trillion in charges and $558 billion in estimated in-network amounts, depending on the incidence rate and severity of the infection in the US population. As reported in a FAIR Health brief released today, COVID-19: The Projected Economic Impact of the COVID-19 Pandemic on the US Healthcare System, this finding is based on FAIR Health projections, derived from estimates issued by public health experts, that from 66 million to 198 million Americans may become infected with the novel coronavirus that causes COVID-19, and that from 4.9 million to 19.8 million of them may require inpatient stays.
The Projected Economic Impact of the COVID-19 Pandemic on the US Healthcare System: A FAIR Health Brief, March 25, 2020
The total average charge per COVID-19 patient requiring an inpatient stay is estimated at $73,300 and the total average estimated in-network amount per commercially insured patient at $38,221.
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A national, independent nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information, FAIR Health drew on its database of over 30 billion private healthcare claim records, and on estimates of Medicare and Medicaid costs, to project US costs for COVID-19 patients requiring inpatient stays. FAIR Health estimated the costs of COVID-19 medical care based on proxy codes used by providers. The findings stated above were based on inpatient ICD-10 procedure codes and revenue codes associated with influenza and pneumonia.
As an alternative, FAIR Health also calculated US costs for hospitalized COVID-19 patients on the basis of diagnosis-related groups (DRGs) associated with pneumonia. On the basis of DRG, the per-patient average costs for hospitalized COVID-19 patients vary depending on severity as indicated by the DRG code, with DRG 193 for major complication or comorbidity, DRG 194 for complication or comorbidity and DRG 195 for no complication or comorbidity. The total average charges per patient range from $74,310 for DRG 193 to $42,486 for DRG 195. The total average estimated in-network amounts per commercially insured patient range from $38,755 for DRG 193 to $21,936 for DRG 195.
Total costs for all hospitalized COVID-19 patients vary on the basis of which DRG code is used. Assuming the highest projected numbers of infected patients needing inpatient stays, the costs range from $1.469 trillion in charges and $575 billion in estimated in-network amounts (for DRG 193) to $840 billion in charges and $329 billion in estimated in-network amounts (for DRG 195).