COVID-19 Testing
The stories are appearing daily – what are the costs for Coronavirus care? Initially, the upfront and center topic was, "How do I get tested and how much will that cost"? On April 24, 2020, the Health Care Enhancement Act was enacted, and things started to become a little clearer – at least concerning testing. There is still some confusion regarding places to be tested, but that is becoming clearer and clearer every day. One popular place these days is right in your own home, simply by ordering a test (one option: https://www.pixel.labcorp.com/)via a website. HealthLink Advocate patients that have gone this route report that they have generally received the test the next day – they utilize the nasal swab, return the test package via any FedEx box, and have mostly heard back (via email) within two days. For this test ($119.00 including the $10.00 physician fee), LabCorp will bill your insurance, submit an invoice to the federal program for those who are uninsured, or for those who choose to do so, allow you to pay out of your pocket on the spot (portal) via a charge card. Assumedly, those who want to pay on their own and not file are those who are zealously guarding their privacy!
Others have opted to visit their Primary Care Provider with hopes of having a test done there. This is a slippery slope, as if you go for a visit and are given a COVID-19 test, you are generally covered for all of your visits, as well as for the testing. However, if you go and your physician decides that you have a cold and does NOT test you, you can be on the hook for the entire visit. Now that is something to think about. This usually holds the same for any Urgent Care or Medi-Center you walk-in to Note: Generally, most insurance plans have agreed that if you are tested for COVID-19, your deductible does not come into play, even if you have a high deductible plan. However, if YOU ARE NOT TESTED, you will be responsible for meeting your deductible, as well as for potential co-pay. As each insurance company treats this situation differently, be sure to check in (the number is right on the insurance card that hopefully you have on your person at all times) and ask before you go what the particular scenario is under the terms of your specific plan.
Advocacy for Continued Testing
One HealthLink Advocate's patient in particular has had great success with the financial responsibility of testing. This patient has been tested for COVID-19 every two weeks for the past six months or so. The patient is undergoing continuing outpatient treatment in a hospital facility, and part of the protocol is to be tested before treatment and entry into the hospital. Initially, the billing for this was tricky. There was sometimes a balance due, but a quick call to the financial services area of the facility would take care of that and the charge would be removed. Now, the entire fee is covered – and it is an expensive one! As the test is done in an outpatient hospital setting, the visit fee is $275.00 and the lab fee is $280.00 – a total of $555.00! Patient responsibility: ZERO.
So – I think that we can agree that the testing questions have been answered in general. Those costs comparably are minimal – at least as compared to the numbers we are hearing for treatment.
High Cost of COVID-19 Care
Months into this pandemic, we are now all aware of the extreme care and high costs associated with those who have tested positive for COVID-19 and need treatment. For patients with minimal symptoms, the costs are mostly manageable. Recuperating at home does not elicit a medical bill, and physician check-ins to follow-up on progress and a path back to health can even be handled via Telehealth, which for the most part (at least for a COVID-19 positive patient) will be cost-free. How is all of this paid for? Well – that depends!
One of the first cases we heard of in our HealthLink Advocates family – positive for COVID-19 was early in the pandemic. This 50ish-year-old, Manhattan-based patient, started with symptoms on March 14th. After being sick for six days, he reached out to his Primary Care Physician who really could not help (COVID-19 tests were not available in physician offices at that time). Given the extent of how much he was struggling, but afraid of further exposing him and others, his physician told him to avoid the hospital, and go directly to a drive-up Urgent Care. Once there, he sat in a lot in his car for two hours before medical personnel queued through the line, and approached his car with a test. It took six days before the results came back – four days after he felt well enough to get out of bed. His cost - $35.00 for a co-pay. The Urgent Care charge was $500.00 to his insurance company, of which they received $250.00 to cover the determined “reasonable” cost. By the way – this patient had a high count of antibodies and participated in the antibody donation program for months afterward. Earlier this fall he was tested again for antibodies (10/9) and was just a little bit relieved to think that he might (still not proven with certainty by infectious disease experts) just have enough antibodies to keep the virus at bay.
However, as the virus stretched on, we are hearing more and more stories about patient experiences in Emergency Rooms, Hospitals, and complications after initial recovery discharges.
When Congress passed the “Families First Coronavirus Response Act” the cost of testing (and eventually vaccination) was addressed. Treatment for COVID-19 positive patients was not. Many, many patients are now struggling with surprise medical bills - with balances totaling thousands of dollars. Reimbursement for treatment has a lot to do with the type of coverage you have.
Let’s break it down into three scenarios:
1. UNINSURED WITH COVID
Believe it or not, being uninsured can be a plus – but only if you know that the Government picks up the tab. If you are uninsured, you are tested for free, and if hospitalized, or even just end up in the ER, even via ambulance, the facility can submit claims electronically to the Federal Health Resources & Services Administration (HRSA) for reimbursement. As long as the facility submits properly, your bill is covered and the facility is barred from billing you for the differences not covered. Unfortunately, those who are uninsured are so afraid of not having insurance that there are reports of patients refusing to go to the hospital, or leaving before they should, afraid of future looming medical bills. Not every hospital has done a good job sharing the news that these costs are covered, and many are just too afraid to stay and take a chance.
In an article published by NPR (https://n.pr/39bhHbk)the story of one such uninsured patient highlights just how deadly not having correct information can be. In the article, Darius Settles opts not to continue care at a hospital as he was afraid of the bill. The hospital did not inform Mr. Settles upfront of its policy for uninsured COVID-19 patients, and that he would not be responsible for the bill. Mr. Darius made two trips to the hospital, according to his wife, panicking about the costs every time. The second time he left, his records disclosed that his lungs appeared worse than the first trip, but even with his persistent struggle to breathe, he opted to leave. The third time he needed help, it was too late. Mr. Settles passed away, his family receiving instructions from the 911 operator on how to perform chest compressions as they tried to save his life at home. Darius Settles was never revived, leaving his widow and six-year-old son behind. As outrageous as could be, the hospital did send a bill. When called out on it, they withdrew the bill and said it was “sent in error”. If you do not have insurance – DO NOT PANIC!
2. INSURED WITH COVID – FULLY FUNDED PLAN
A United Health Care covered COVID-19 patient, David Lat, published a story this month (https://bit.ly/2KutuXD) detailing his journey through Covid-19 treatment and the costs he endured. Mr. Lat had health insurance, and from his hospital bed, he was so anxious about the costs, he logged on to his member website. He was relieved to find that the hospital was in-network. Good thing, as the total cost of his treatment, added up to approximately $320,000. Of that, he was not responsible for any of that bill. As confusing as it is, the term "Cost-Sharing" is important here. Many of the major healthcare companies have waived all "patient Cost-Sharing” for treatment of those insured with Covid-19. “Cost-Sharing” means that you are not responsible for any deductible, or any co-pays.
Not all insurance companies have opted into the “Cost-Sharing” model, and assumedly that is where we are hearing more and more about high, unpaid bills. Mr. Lat was lucky. He worked for an employer who was in a plan noted to be “fully-funded”. A fully funded health plan is a plan where an employer purchases health coverage from an insurance carrier for a per-member premium. The insurance provider assumes the risk. These plans are the most common to have jumped on and embraced the “cost-sharing” model, many under pressure during COVID-19 from politicians and the public.
3. INSURED WITH COVID – SELF-FUNDED PLAN
However, not everyone is on a fully-funded health plan. Many employers have chosen to self-insure, and opt for a "self-funded" health plan. In a “self-funded” plan, employers opt to self-insure, hoping to save on premiums. However, this exposes the company to large risks in the time of, say, a pandemic, as an unexpected amount of claims will be generated. Unfortunately, self-insurance puts these companies at a much greater risk for high claims than plans in the “fully-funded” pool. The employers of these plans were under much less public pressure to incorporate “cost-sharing” as they were already struggling in the pandemic induced financial crisis, many not incorporating “cost-sharing” into their post-COVID-19 model.
These are the plans to worry about, should you become infected with COVID-19. Many, many people, already confused about the influx of information coming their way have no idea if they are on a “fully funded” health plan that might have opted into “cost-sharing”, or a “self-insured” plan with no such stop-gap protections.
Of course, as long as you stay in-network, let your provider know that you are hospitalized, and are prepared to pay your deductible and co-pays, you have some protections. Almost every plan has an "out-of-pocket" limit, and hopefully, when you signed up, you were paying attention to what that bottom line number would be. Those that opted for a high-deductible plan, insured through a self-funded plan who did not opt into “cost-sharing” will have a struggle ahead.
Just know that the struggle is not absolute. No matter what plan you have, you have a lot of avenues to follow before you pay any bill. You will be surprised to learn what a call from you, or your advocate can change. There are a lot of options here – you just need to try.
As for now – call your insurance company. Be proactive! Find out if you are in a plan that opted for “cost-sharing” if you develop COVID-19 and what would that mean for you? Will your deductible and co-pay be waived if you develop COVID-19 and need treatment? Does that extend to the hospital (facility) as well as the physicians treating you? Make sure that you know which hospital near you is in-network. If you are in open season, think about changing your plan (if possible) to one with a lower deductible if you are in a self-funded plan. At least until we are out of the pandemic.
As for the “cost-sharing”, many plans have only opted to continue this until December 21, 2020. Things are changing every day, so do your best to be aware of your options - no one, not anyone of us should be in a hospital ICU looking up our benefits to relieve our already over the top anxiety.
Make the call now!