Family socked with 'mind-blowing' bill for toddler's routine illness tests

An Illinois family was shocked by an exorbitant bill for routine medical tests for their toddler daughter.

The 3-year-old was sobbing uncontrollably last December after being put down for bed, and her mother Maggi Wettstein feared she might have another yeast or urinary tract infection, which had already happened during potty training. So they took the girl around 10:30 p.m. to a nearby emergency room operated by Carle Health, reported the Washington Post and KFF Health News.

The ER wasn't busy when they arrived before 11 p.m., and medical records indicated the toddler was given a nasal swab test to check for COVID-19 and influenza, but her mother said the child noticeably calmed down as they awaited the results, so they decided to leave.

"[The girl] had preschool the next day, and [her mother] figured there was no point keeping her awake and getting stuck with a big ER bill," the newspaper reported. "There was no one at the check-in desk to inform that they were leaving, Wettstein said, so they just headed home to go to bed. Ryan went to her preschool the next day, and Wettstein said they didn’t think about the ER trip for eight months."

"Then the bill came," the report added.

The hospital billed $445 for the combined COVID and flu test, and even though the family never saw a doctor, they owed $298.15 after an insurance discount, which Wettstein thought seemed unusually high since she had seen that Walgreens sells an at-home Covid-flu combination test for $30 and can perform higher-quality PCR testing for $145.

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Insurance companies had been required to pay for COVID tests without passing the costs on to patients, but bills for those tests skyrocketed when the public health emergency declared in 2020 expired in May 2023. ER tests have become notoriously expensive.

“That’s a pretty healthy markup the hospital is making on it,” said Loren Adler, associate director of the Brookings Institution’s Center on Health Policy. "[The hospital is ] utilizing their market power to make as much money as possible, and the insurance companies are not all that good at pushing back."

The family’s insurer, Cigna, did not have to pay for the testing because the family hadn't met its $3,000 yearly deductible, and a spokeswoman for the hospital did not respond to specific questions about the bill.

“We follow policies that support the safety and wellbeing of our patients, which includes the initial triage of symptomatic patients to the Emergency Department," said Brittany Simon, a public relations manager for Carle Health.

Wettstein said what had happened to the hospital's billing staff, which told her not to pay until it was reviewed. But the hospital eventually notified her the charge was correct, even though her daughter was never seen by a physician.

"The fact that I never saw a provider, and the fact that it was just for a COVID test, is mind-blowing to me," Wettstein said. "I guess I have to pay this."