Depending on where they live, coronavirus can still cost Americans thousands of dollars

Testing is free. The rest, not so much
Testing is free. The rest, not so much
Image: Reuters/David Ryder
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Relatively early in America’s adventures in coronavirus, on March 18, the US government approved legislation that made  coronavirus testing, as well as the visit to administer it, free for all Americans, whether or not they have health care insurance (although if the visit doesn’t result in a coronavirus test, it is not covered).

It was an essential policy: The fear of medical bills acts as a deterrent for many Americans, pushing them to delay, or avoid, tests or medical treatments. Any hope of containing, or even simply tracking, the epidemic rests on widespread testing, so free access was paramount. That has become especially so as millions of Americans have lost their jobs, with many also losing their healthcare benefits.

But much as coronavirus tests are essential to diagnose cases and track the spread of Covid-19,  they are only a small part of the costs associated with the disease. Medicaid and Medicare, for instance, pay around $60 for the swabs to detect the infection, but other tests—to assess lung damage caused the virus, for example—can be far more expensive, which makes the federal government’s policy insufficient.

Add to that the cost of treatment, especially in the case of hospitalization, and the bill might go up significantly, and one in seven Americans say they would avoid seeking treatment because of the expense.

How expensive coronavirus can be for patients depends very much on individual insurance coverage, but also on state regulations.

As of today, only a minority of states have issued regulations addressing the ways medical billing for coronavirus could get out of hand, which is limiting the inclination of potential patients to seek care.

Uninsured patients

As of the end of 2019, about 28 million Americans were without health insurance. While there are local options for them to receive support to cover health expenses, so far the federal government has primarily addressed the issue from a provider’s perspective: Hospitals and other healthcare centers who are testing or treating uninsured Covid-19 patients can request reimbursement—at Medicaid rates—through a federal portal.

There are a few important exceptions, however, which leave providers—and, as a consequence, patients—at a risk of getting hefty bills for coronavirus treatment. For instance, the federal provisions don’t cover undocumented immigrants, although about 6 million of them (45% of the estimated total) are uninsured.

But even for patients who otherwise qualify for the assistance, coronavirus treatment is not reimbursed by the government relief if it isn’t the main reason of hospitalization. For instance, if someone developed coronavirus symptoms alongside another pathology, such as cancer complications, they were already receiving treatment for, they won’t be covered. The only exception is pregnancy.

Hospice services and drugs for patients not admitted to the hospital are also not covered, nor are the costs of diagnostics or treatment for those suspected of having Covid-19, who then tested negative.

Additionally, the federal Covid-19 relief fund is set up for providers, so it’s up to them to decide whether to treat and charge the patient, or apply for the fund, said Cheryl Fish-Parcham, a director at Families USA, a national, nonpartisan consumer healthcare advocacy organization. Uninsured individuals don’t have independent access to the fund, which means they can’t ask for government reimbursement, or support, after paying for the treatment out of pocket.

Insured patients

Things are somewhat more complicated for patients who are insured.

Take, for example, the case of someone who tests positive for coronavirus and then develops serious complications. They are admitted into the hospital, where they are taken put under intensive care and intubated for several days, or weeks. What will their bill look like?

Depending on the state and their insurance, it can vary from thousands of dollars to $0,

A handful of states—Massachusetts, Michigan, Minnesota, an New Mexico—as well as Washington, DC, have approved legislation requiring insurance providers to waive the patient’s costs of treatment, including co-pays and deductibles, and testing associated with a coronavirus diagnosis. Idaho, while not requiring they do so, recommends it.

On top of that, some insurance providers have decided to waive the costs for their plan holders, irrespective of location. In most cases, the waivers are supposed to be in place for services received until May 31.

But even then, things aren’t so clear-cut. In Minnesota, for instance, the waiving of cost is only guaranteed for in-network hospitalization, and so patients who end up using providers outside their network might have to pay regardless of the diagnosis.

Where the state hasn’t expressed clear requirements about cost-waiving, even the insured may be forced to meet their deductible, which can be high, particularly given the increase in enrollment into high deductible health plans in the past few years.

Is that it? Of course not.

Enter surprise billing, or what happen when your health care provider might be in-network, but one or more of the doctors or nurses actually treating you might still be out-of-network. This is something that is high up in the list of America’s healthcare cost-related worries, and is especially common in emergency cases: An estimated 18% of all ER visits incur into at least one out-of-network billing. In-hospital admissions also frequently run into surprise billing—on an average, 16% of the time—and surprise billing is more common in urban areas.

Out-of-network billing can be substantial, often doesn’t benefit from insurance discounts, and isn’t necessarily bound to any out-of-pocket maximum. Analyses have found the average cost of a coronavirus treatment is around $30,000, but it could go much higher, particularly for patients in need of a ventilator for an extended period. For them, the price tag could get close to $90,000.

Coronavirus is a perfect storm of surprise billing, with most patients hospitalized via an emergency visit, and in an urban area. Which is why Massachusetts, Ohio, and Wisconsin have adopted Covid-19 specific regulations forbidding surprise billing in relation with coronavirus diagnosis, joining a majority of American states which already have some provision protecting patients from surprise billing.

Still, this leaves over 15 states with no provision to protect patients from surprise billing. A coalition of patient advocate organizations, including Families USA, urged federal lawmakers to forbid insurers from billing services as out-of-network when they were incurred for coronavirus treatment. Two months into the emergency, congress has yet to act.