Insurance companies are quickly responding to the coronavirus pandemic to make sure beneficiaries can get tested and treated for COVID-19. However, providers are still having trouble when it comes to billing their patients, forcing some patients to spend thousands of dollars out of pocket.
Across the U.S., we’ve seen several incidents of providers overcharging their patients for COVID-related services. With so many people unemployed across the country, millions may be unable to afford medical care as it relates to the pandemic.
Let’s find out why patients are paying thousands of dollars for coronavirus testing and treatment, and how you can prevent it.
How the Insurance Industry Is Responding to the Pandemic
Both Medicare and Medicaid have announced that they are waiving the cost of coronavirus testing for all beneficiaries. Patients should be able to get tested at the hospital, doctor’s office, or urgent care clinic free of charge. This should help communities better monitor the spread of the virus among the local population. If patients, especially elderly and low-income individuals, forgo testing and treatment due to various financial concerns, the virus will likely continue to spread at an alarming rate.
The pandemic is affecting everyone simultaneously, and the insurance industry is doing its best to come up with a coherent solution. Every insurance provider has its own plan for covering COVID-related expenses. To find out if your health plan covers COVID testing and treatment, visit America’s Health Insurance Plans to view a full list of insurance providers and how they are responding to the pandemic.
Many states have also waived the cost of COVID-19 testing and treatment. If you live in New York, you should be able to get tested and treated for the virus free of charge if you have employer-sponsored insurance. Several states have also created special health insurance enrollment periods to help the uninsured and newly unemployed find coverage.
Surprise Bills Related to COVID-19
Despite these consumer protections, many patients are falling through the cracks. In order for these protections to apply, providers must classify their patients as having COVID-19, so the insurance company will cover certain fees and expenses – not the consumer.
In one instance, a patient in Denver, Timothy Regan, was experiencing intense coughing fits and suffering from a mild fever. He called the local coronavirus hotline and described his symptoms to the nurse on the other end of the line. She told him to go directly to a hospital or urgent care clinic.
Fearing a surprise bill, Reagan found an in-network hospital in the Denver area. He went into the ER where he was given a chest X-ray and an EKG, but everything looked normal. The doctor told him to presume he had COVID-19, even though he wasn’t tested, and to quarantine for at least 2 weeks to prevent spreading the virus. He also prescribed an inhaler to help him breathe. After just two hours, Reagan was back at home.
A few weeks later, he and his wife, who was pregnant with their second child at the time, were feeling well again. Then, they received a bill from the hospital.
As it turns out, Denver Health charged Reagan $3,278 for the ER visit. His insurance plan came with a $3,500 deductible. While his insurer paid $1,042, he had to pay $2,236 out of pocket, including most of a $2,921 general ER fee.
He eventually called his insurer to complain. The hospital says he wasn’t tested for COVID-19 because he was not considered a high-risk patient. He wasn’t over the age of 65 and he didn’t have any pre-existing conditions such as asthma or diabetes. Thus, the nurse on staff didn’t classify Reagan as a COVID patient, which means he was not eligible for the consumer protections mentioned above. The insurance company finally got to the bottom of the situation and found that the hospital should have classified Reagan as a COVID patient.
First Come, Last Served
Patients that were treated for the virus earlier on in the pandemic may also be dealing with surprise medical bills. A 25-year-old New Yorker named Christopher Hoffman went to an urgent care clinic for flu-like symptoms back in early March before much of the country was even aware there was a pandemic.
The urgent care clinic did not test Hoffman for the virus because he didn’t have a fever at the time. However, his symptoms quickly intensified and a week later he was in the hospital on an IV. He has since recovered from COVID-19, but now he has to figure out how he’s going to pay more than $3,800 in medical bills.
Again, the hospital did not classify Hoffman as a coronavirus patient. In order to rid himself of this debt, he must prove his illness was virus-related.
Chaos in America’s Insurance Industry
Even as the insurance industry works to address these issues, healthcare providers are struggling to keep up. They have to deal with and make sense of dozens of different private and public health plans, new treatment methods, and other variables related to COVID-19 treatment.
Some experimental drugs that are being used on a limited basis to treat the virus may not be covered by insurance. Providers may also make a mistake when classifying and billing their patients. Different hospitals are using different treatment methods for COVID-19, and some insurance companies may cover one method and not the other.
Some insurance companies do not cover the entire testing process. Certain elements in the testing supply chain may leave the consumer with a surprise bill.
As a nurse or care provider, do your best to update your billing practices as these guidelines change over time. Use caution when classifying your patients to limit the number of surprise bills. For example, can you classify a patient as COVID even if they haven’t been tested?
Nurses and providers have also had to pay for COVID-19 treatment out of pocket. Monitor your own health insurance plan to make sure you can get treated and tested for the virus when the time comes. Hopefully, the insurance industry will reach a consensus soon, so everyone can get the care they need without paying out of pocket.