The Sky-High Cost of Some COVID-19 Hospital Bills
Loopholes in the law that supposedly makes coronavirus treatments 'free'
You may have heard that a law Congress passed this spring (The Families First Coronavirus Response Act) said health insurers would cover the cost of COVID-19 testing. But the law didn't include the cost of coronavirus treatment.
As a result, some of the 476,000+ Americans hospitalized with the disease have found themselves with staggering hospital and ambulance bills. Some patients — and 90,000 are now being diagnosed with COVID-19 daily — are reporting surprise medical bills in the tens of thousands of dollars.
Christine Lewis of Atlanta is still sorting through the huge COVID-19 medical bills for her husband Ron, 60, a retired teacher who died from the disease in May a few days before the couple's anniversary.
"I think we are looking at $15,000 in bills, even with our coverage," she says.
"Ron ended up in the hospital for a month before he passed away. He was on a ventilator and had a stroke," Lewis says. "It is horrible to lose your husband to this disease. And it's worse to struggle to pay the medical bills from care that didn't save his life."
Linna Wolk, a 62-year-old customer service representative in Grand Rapids, Mich., is considered a COVID-19 long hauler, meaning she had illness due to the virus far beyond two weeks. She was diagnosed in May and hospitalized for four days.
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A COVID-19 Long Hauler's Medical Bills
"I thought I was on the mend and then I kept having setbacks," Wolk says of the migraines she developed after her diagnosis. She also has low energy and gastrointestinal problems.
"I am sitting on three thousand dollars in extra medical bills."
While no longer being treated for the coronavirus, Wolk — who bought health insurance on an Affordable Care Act exchange — is under medical care for her long-haul illnesses. So far, she has had to pay $2,500 in out-of-pocket expenses related to her COVID-19 care in the hospital.
What's more, she adds, "I am sitting on three thousand dollars in extra medical bills, over the costs of my insurance and as long as this virus hangs on, I can't see that the bills will ever end."
Then there's Cleveland tech entrepreneur Cyrus Longworth, 56, who got COVID-19 in April despite being otherwise healthy and active.
After getting winded from a run, Longworth got a COVID-19 test which came back negative. But he was spiking a temperature, lost his sense of taste and smell and was still having a hard time catching his breath within eight hours of his first symptom. After a battery of medical tests, "one of my scans showed that my lungs looked like they had been hit with tiny buckshot, which my doctor said explained the breathing challenges," Longworth says.
'I Was Shocked'
"At last count, the cost of my care was at $48,000, and that doesn't count the medication for the damage to my lungs, that I will probably be on the rest of my life," says Longworth. "I was shocked."
Fortunately, Longworth, who is home now, has health insurance coverage through his wife's job (she's a physician at the hospital where he received care). So, he only had to pay a few hundred dollars in out-of-pocket costs.
The costs and quality of coronavirus came into focus recently when President Donald Trump contracted the virus in September and got cutting-edge care. That included multiple tests, oxygen, steroidal treatments and Remedesivir, an experimental antibody treatment recently approved by the Food and Drug Administration for COVID-19 treatment (typical cost: around $3,100), if you can get it. He was also given the experimental drug Regeneron, which is in clinical trials but not widely available to public.
If you aren't the President of the United States and contract COVID-19, however, your costs will depend on a few things: whether your medical and related services (such as medical labs) are in-network or out-of-network; whether you have private health insurance, Medicare or Medicare and supplemental insurance; whether your health insurance policy is a standard type or a skimpy one that won't cover many COVID-19 costs; whether you need treatment for long-term symptoms; and — the especially pernicious part— if you do have employer-sponsored health coverage, whether that insurance is what's known as "self-funded" by the employer.
What Determines How Much You May Owe
According to a recent study by the nonprofit health data service FAIR Health, the national median charge for COVID-19 inpatient care for people in their 50s who didn't have health insurance or those who received out-of-network care was about $45,600.
A common loophole to the new law's "free" COVID-19 treatment: out-of-pocket costs from things like emergency room visits — those doctors are often out-of-network — and return visits to the hospital without coronavirus tests.
One giant surprise bill that some hospitalized coronavirus patients have received: out-of-network ambulance and air ambulance trips. In one study, up to 71% of ambulance rides led to surprise, out-of-network bills.
A recent New York Times article told the story of one 60-year-old woman with COVID-19 who owed $52,112 for an air ambulance from one Philadelphia hospital to another. Her health plan did not pay a penny of that cost.
Some private health insurers — such as Cigna, Humana and United Healthcare — have voluntarily waived patient cost-sharing (like co-payments and annual out-of-pocket deductibles) for COVID-19 treatments for some beneficiaries. But others haven't.
Which Insurers Are Waiving Costs
If you have employer-provided health insurance, whether you'll be eligible for the COVID-19 medical cost waivers may depend on whether your plan is "fully-funded" or "self-insured." The vast majority of employer-sponsored plans from large businesses are self-insured, which means the companies pay for employees' health care costs, not the insurers themselves.
Don't be afraid to push back on bills that come from your health care provider.
If you are 65 or older and on Medicare, you'll be subject to the Medicare Part A annual deductible of $1,408 in 2020. You'll also owe daily co-payments for extended inpatient hospital stays. For stays of two to three months, you'll owe a $352 co-payment per day. If you'll need post-acute care following a hospitalization, you'll then owe co-payments of $176 per day. And for COVID-19 treatment-related outpatient services covered under Medicare Part B, there's a $198 deductible in 2020 and 20% co-insurance for most services.
Medicare supplement coverage covers some or all of your cost-sharing requirements. And private Medicare Advantage plans (alternatives to traditional Medicare) often charge daily co-payments for inpatient hospital stays, emergency room services and ambulances. These plans may waive or reduce cost-sharing for COVID-19 related treatments and most are temporarily waiving the costs currently.
According to a recent Scientific American article, "COVID's Other Toll: Unnecessary Tests and Huge Hospital Bills," some hospitals and doctors have reportedly insisted that patients diagnosed with COVID-19 get a battery of special tests, known as a "blanket standard of care," even though all of the didn't need those tests.
Here are a few ways you may be able to keep your costs down if you have had COVID-19 or get it:
How to Help Keep COVID-19 Hospital Bills Down
- Understand the ins and outs of your health care coverage. You’ll want to know things like: What does your insurance cover? Does it tease out COVID-19 coverage from any other medical treatment that might be caused by having the coronavirus? Does your coverage pay for state of the art medications? If you must go on a ventilator, what will it cover and for how long? Does it treat COVID-19 hospitalization different than other hospitalization?
- If you have Medicare, consider adding supplemental coverage during open enrollment. It might help offset the costs of care. Open enrollment is happening now and continues to December 7.
- If you don’t have health insurance, look into your options under the Affordable Care Act (ACA). You can do this by going to the government’s Healthcare.gov site. While there is some question about what will happen with ACA due to a coming Supreme Court case, it’s currently the law of the land. Open Enrollment for ACA plans is happening now and goes until December 15 for coverage that begins January 1, 2021.
- Review all medical bills you receive. Don’t be afraid to push back on bills that come from your health care provider. And ask your insurer whether the charges are valid.