$80,000 and 5 emergency room visits: An ectopic pregnancy takes its toll despite New York's liberal abortion law

$80,000 and 5 emergency room visits: An ectopic pregnancy takes its toll despite New York's liberal abortion law

When Sara Laub's period was late, the New Yorker shrugged her shoulders. She had used an intrauterine device (IUD) for three years and knew her chances of becoming pregnant were extremely slim. But after ten days had passed, 28-year-old Laub took a home test in early July and received the unwelcome news: she was pregnant.

Laub went to a Planned Parenthood clinic because she knew someone would be able to see her right away. An ultrasound showed no signs of a developing embryo in her uterus. That suggested the possibility that Laub might have one Ectopic pregnancy A fertilized egg implants itself somewhere outside the uterus, usually in the fallopian tube.

Such pregnancies are rare and occur in about 2% of cases. However, they are extremely dangerous as a growing embryo could rupture the tiny tube, causing massive and potentially life-threatening internal bleeding. Laub experienced no pain, bleeding, or other obvious symptoms of illness. Still, a Planned Parenthood employee recommended she go to a hospital emergency room immediately.

Laub was unaware of it, but she underwent lengthy – and very expensive – treatment to terminate the pregnancy. Even in a state that strongly supports a person's right to make their own decisions regarding pregnancy - New York legalized abortion in 1970 three years before Roe v. Wade legalized it nationwide - Laub's experience shows that the process can be arduous.

An ectopic pregnancy in the fallopian tube is never viable. But after the Supreme Court overturned the Roe ruling in June, reproductive health experts say care could be dangerously delayed as some states take action to restrict abortion services.

Some of these consequences are already being seen in Texas, which implemented strict abortion restrictions last fall ahead of the Supreme Court's decision. Since abortions in Texas are now only allowed in medical emergencies, doctors could wait to perform abortions until pregnant patients experience life-threatening complications in order to comply with the law.

“In Texas, we saw people not treating ectopic pregnancies until they ruptured,” Dr. Kristyn Brandi, an obstetrician-gynecologist in Montclair, New Jersey, who is the board chair of Physicians for Reproductive Health, which advocates for abortion rights.

The 2021 Texas law banned most abortions around the sixth week of pregnancy. Researchers at the University of Texas-Austin surveyed doctors about the law's impact on maternal and fetal care. A specialist at an unnamed hospital said the facility said no longer offers treatment for certain ectopic pregnancies.

Um half of the states Have enacted abortion restrictions or are attempting to do so.

Laub, who is identified by her first and last name because of her privacy concerns, said she couldn't help but think about the recent Supreme Court decision as she went through diagnosis and treatment.

“As frightening as my ordeal was at the time, I was keenly aware that I was fortunate to have easy access to treatment, and women elsewhere with my condition have much worse experiences,” Laub said.

In the emergency room at Lenox Hill Hospital on New York's Upper East Side, doctors ran more tests and gave Laub two options: an injection of methotrexate, a cancer drug that destroys rapidly dividing cells and often used to end an ectopic pregnancy, or surgery to remove her fallopian tube that contained the fertilized egg.

Laub decided on the injection. After vaccination, patients will need to have further hormonal blood tests to confirm that the pregnancy has ended. Three days after the vaccination, Laub returned to the emergency room for blood work and an ultrasound. She returned three days later and received a second injection of methotrexate because the pregnancy had not yet been terminated. The following week, she repeated the treatment at two follow-up visits. On July 20, after 12 days and five emergency room visits, Laub was scheduled to undergo laparoscopic surgery to remove her fallopian tube.

The total cost of medical treatment so far is a staggering $80,000. Because her health insurance company had negotiated discounted rates with the hospital and the other providers, all of whom were in her provider network, Laub's out-of-pocket costs will only be a fraction of that total. It now appears that Laub will owe just over $4,000.

That still seems like a lot, she said.

“On the one hand, I am grateful that I was able to receive treatment when I was not in an acute condition,” Laub said. “But it’s a terrible feeling knowing that the decision I made about the best path in care came at such a high cost.”

However, the hospital pointed out that its fees were reduced by Laub's insurer discount. "Fees are based on the specific services provided in the patient's care," said Barbara Osborn, vice president of public relations for Northwell Health, a system that includes Lenox Hill Hospital. “Any amount payable by the patient is based on the benefit design and cost-sharing provisions of the patient’s insurance plan.”

It can be difficult to understand hospital costs because they often don't seem to match the actual cost of care. That's true in this case. According to a breakdown from WellRithms, a company that analyzes medical bills for self-funded companies and others, Lenox Hill Hospital charged an average of $12,541 for the surgery Laub underwent, based on publicly available data that hospitals submit to the federal Centers for Medicare & Medicaid Services. But the hospital charged Laub's health insurance $45,020.

“Hospitals will charge whatever they can,” said Jordan Weintraub, vice president of claims at the Portland, Oregon, company. “They force the payer to reject items instead of billing them properly.”

Even more revealing is how much it actually costs the hospital to perform the surgery. According to WellRithms' analysis of federal data, the cost to perform the laparoscopic procedure on Lenox Hill is $3,750. The average cost statewide is $2,747.

According to Fair Health, a nonprofit that manages a large database of health insurance claims, the average outpatient fee nationally for the surgical procedure Laub received is $13,670. The average total amount paid by the health insurance company and the patient is $6,541.

The surgical cost of treating an ectopic pregnancy varies greatly by location. However, the fees are not necessarily related to facilitating access to medical care to terminate a pregnancy. In the New York City metropolitan area, for example, the average fee is $9,587, while in San Francisco it averages $20,963, according to Fair Health. Both New York and California have generous abortion access laws. Meanwhile, places with more restrictive abortion standards don't necessarily charge more for ectopic pregnancy surgeries. For example, in the Dallas area, the average fee is $14,223, while in Kansas City, Missouri it is $16,320, both of which are lower than the average fee in Chicago ($18,989) or Philadelphia ($17,407).

Many women choose methotrexate instead of surgery to treat an ectopic pregnancy. The drug is successful in 70-95% of cases without the need for surgery.

The drug is often administered in a hospital because gynecologists are unlikely to keep the cancer drug in their practices, experts say. After the injection, patients must be closely monitored until the end of the pregnancy as the risk of life-threatening rupture remains. In addition, patients will need to have blood tests at regular intervals after an injection to confirm that their pregnancy hormone levels are decreasing.

After receiving her first injection in the emergency room, Laub was told she would have to return for further blood work after each injection. The cost of these emergency room visits was likely significantly higher than if Laub had received outpatient follow-up care from a gynecologist. For each of these follow-up visits, the hospital charged between $4,700 and $5,400. Laub's share of the cost was about $500 each time.

“She had a long treatment period and if everything was done through the emergency room that would be unfortunate,” Dr. Deborah Bartz, a gynecologist at Brigham and Women's Hospital in Boston. “It would be really nice if it could have been incorporated into the outpatient setting with a protocol to manage monitoring instead.”

In a statement, Osborn defended the hospital's approach.

“Ectopic pregnancies, which can be life-threatening conditions, require careful monitoring and treatment to ensure successful resolution,” Osborn said. “The emergency situation allows for the immediate availability of critical surgical services, as was ultimately necessary in this patient’s case.”

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