Received treatment for COVID-19 and received an exorbitant medical bill? You’re not alone.
Almost 3 million Americans have already been infected by the Coronavirus. And for those who received treatment or hospitalization, the medical bills are now rolling in. Many of those bills are exorbitant, capping out in some cases at $400K and even $1.1 million. Shockingly, many of the patients receiving these surprise bills are insured or covered by government relief.
COVID-19 is the topic du jour, putting those infected at the mercy of the already-fragmented healthcare system. Medical bills are already known for being error-prone and needlessly complicated. But with new Coronavirus treatments and various government relief packages, the confusion about what is truly owed has only increased.
The Issue with COVID Hospitalization
Once a patient with Coronavirus symptoms is admitted to the hospital, they are seen by a parade of doctors, one after the other. But after signing intake paperwork, patients have little control over who sees them or what treatments are administered. Especially if they are in critical condition — or unconscious. The surprise comes once the bills arrive in the mail.
Coronavirus patients are at even greater risk for medical overcharging than typical patients. The average hospital stay for a Coronavirus patient is 10 to 13 days. Should the patient require a stay in ICU, their cost could average $30,000, according to America’s Health Insurance Plans (AHIP)
And when a ventilator is needed, the cost will likely skyrocket even further. A Kaiser Family Foundation study found that a privately insured patient may be charged an average of $88,000 for four days of ventilator support.
While these charges are not necessarily what a patient will pay, patients with employer health care coverage may expect to shell out $1,300 or more out-of-pocket for COVID hospitalization.
For those who are uninsured or receive out-of-0network COVID treatment, FAIR Health estimates they’ll pay between $42K and $74K.
Surprise Billing Cases
Here’s a breakdown of real life cases of patients who received shocking bills related to Coronavirus testing and treatment.
Case 1: Hospital, ICU, and Ventilator Charges Total $1.1 million
Michael Flor, 70, of Washington state, spent over two months in the hospital with COVID-19, a stay which included a month in ICU. Once released, he later received a $1.1 million bill, with charges totaling nearly $10K per day. Flor will likely pay for very little of the charges due to Congress aide and his Medicare Advantage policy, but that doesn’t change the fact that he was billed directly.
Case 2: A Tale of Two Bills – $199 vs $6,408
Two friends in Texas decided to electively test for Coronavirus in advance of a small group camping trip. The two received drive-thru tests at Austin Emergency Center in Austin with one friend paying $199 in cash, while the other paid with insurance. After returning from the trip, the insured patient later received a bill for $6,408 – 32 times the cost of what the cash patient paid – for the exact same test. The health insurer managed to negotiate the total bill down to $1,128, but the plan said she was still responsible for $928 of that. Why the drastic difference?
There’s clear evidence of a wide variation between what providers bill for the same basic diagnostic tests and treatments. It turns out there is also significant variation in how much a test can cost two patients at the same location. If you do get tested for Coronavirus somewhere other than a designated free location, you might want to check with your carrier on the negotiated rate for that location in advance to avoid any surprises.
Case 3: Erroneous Bill Totaling $400,000
Janet Mendez nearly died of Coronavirus, and was unconscious for much of her stay in the hospital. Upon returning home, Ms. Mendez received a bill for $401,885.57, with a note that the hospital would cover all but $75,000 of the charges.
Her bill included individual fees from doctors charging between $300 – $1,800 per day. And some days, she was billed by four different doctors for treatment. It was later determined that the bill was erroneous, and instead should have been sent to Ms. Mendez’s insurance or the government.
After her insurance company pays, Ms. Mendez will likely owe less than $10,000, but in the meantime she is receiving harassing calls from the hospital for payment. Incidentally, the hospital who treated her, Mount Sinai Morningside, received over $63 million in federal aid.
Case 4: Duking it Out with Insurance
Christopher Hoffman was billed more than $3,800 in out-of-pocket expenses for his urgent care and hospital visits, and is uncertain how much his health insurance will actually cover. Part of the issue Hoffman faces is that he was never officially diagnosed with Coronavirus, as he fell sick outside the timeframe when testing and federal aid measures were enacted. Remarking on the battle to have his medical bills covered, Hoffman says, “I’m going to have to duke it out with my insurance company.”
Case 5: $48,000 Due to No Pre-Approval
Anne Bakjian, 40, of Georgia, received a bill for her two-week hospital stay battling Coronavirus. Her bill totaled $48,000. As an explanation, she was informed that her low-income Medicaid program, Peach State Health Plan, had denied her claim, since her care hadn’t been pre-approved. Of the high-ticket bill, Bakjian says, “If you’re on Medicaid, you don’t have that kind of money.”
Patients treated for Coronavirus who have received surprise bills have voiced a number of similar complaints. Perhaps the most common complaint is that hospital bills are not properly itemized. Charges shown are often vague and arbitrary, listing generic terms such as inpatient charges and pharmacy charges. And due to the newness of the pandemic, drugs offered as Coronavirus treatment, although FDA approved, are often not covered by insurance. Sadly, signing into the hospital feels to patients like signing a blank check, a waiver for any and all charges, without much transparency or patient control.
Impact to Patients in Need of Care
Many Americans already know the burden of owing large medical bills. A Kaiser Family Foundation study found that nearly a quarter of Americans state that they or a family member have struggled to pay a medical bill in the last year. This fear of adding new bills keeps many from seeking treatment. A recent Gallup and West Health study found that one in seven adults say that if they experienced a fever and dry cough, they’d avoid seeking medical care due to the cost.
When Help Isn’t There (But Should Be)
Both the government and insurance companies have promised to help with most Coronavirus testing and treatment costs. Congress has authorized more than $175 billion of relief for providers assisting Coronavirus patients.
But existing fragmentation within the healthcare system is already showing patients falling through the cracks. You can learn more about the staggering cost of US healthcare waste here.
While many of the largest health insurance companies announced at the onset of the pandemic that they’d waive patient copays, deductibles, and coinsurance for COVID-19 treatments, many of these assistance programs have since expired.
What Can Patients Do?
Received a hefty bill? You have the right to challenge the charges. Ask your hospital to draw from governmental relief before trying to collect from you.
Finally, instead of resorting to “duking it” out with the insurance company, there is a better way. HealthLock is on your side. We can audit your COVID related medical bills, verifying what’s fair to pay, and what’s not. Learn more about how HealthLock can help you today.