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The COVID-19 safety net has many holes in the United States



COVID-19 can do more than physically torture patients. He also bites some financially.

Although many insurers and the U.S. government have offered to bear or waive the cost of the virus, there are still holes in big bills to sneak in and surprise patients.

People who fail a test to show that they have the virus and those who receive care outside their insurance network are particularly vulnerable. Who provides coverage and how hard the patient struggles to reduce the bill may also matter.

There are no good estimates of how many patients have been affected by large bills because of the coronavirus. But the pandemic, which arrived earlier this year, revealed well-known shortcomings in a system that mixes private insurers, government programs and different levels of coverage.

“Unfortunately, there are many times in our system when people will fall through the cracks,”

; said Sabrina Corlett, co-director of the Center for Health Insurance Reforms at Georgetown University.

More than 7 million people have confirmed cases of COVID-19 since the virus began spreading earlier this year in the United States, according to Johns Hopkins University.

Most of these patients will incur little medical costs while waiting for their body to fight the mild symptoms. But patients who visit emergency rooms or are hospitalized can be financially vulnerable.

Melissa Szymanski spent five hours in an emergency room in Hartford, Connecticut in late March and ended up with bills totaling about $ 3,200.

The problem: The 30-year-old elementary school teacher was unable to get tested because she was battling a fever and her doctor wanted an X-ray of her chest. At that time, the hospital limited the tests and it did not meet the requirements.

Szymanski was never diagnosed with COVID-19 at the hospital, and her insurer, Anthem BlueCross BlueShield, said she would have to pay the high deductible on her plan before coverage could begin.

The account left her motionless.

“I was surprised to receive a bill because it seemed clear it was COVID,” said Szymanski, who also shared her story with the patient’s lawyer about patients’ rights.

Szymanski later received a blood test that showed he had the virus and is working to reduce the bill.

Mary Lynn Fager also fell ill in late March from a suspected COVID-19 case and did not receive a single bill. Fager spent four days in a hospital with oxygen and had several doctor’s appointments.

Eventually, she asked someone at the hospital about the price and they said she should not receive bills. Fager had lost her job in March and qualified for the Medicaid coverage program in New York. She said she had borne all the costs.

“I couldn’t believe it,” she said. “Even when I couldn’t breathe, it was on my mind the whole time I was there. I was thinking about hospital bills. “

Separately, the federal government said it would rebuild hospitals that treat uninsured patients for COVID-19. And 78 insurers have waived expenses such as deductibles or payments for individuals covered by their plans, according to the Kaiser Family Foundation.

Many large employers who pay their own health care costs have done the same. But these failures are not universal and have limitations. Some expire later this year.

Denials can also only be good for care sought within an insurance network of doctors and hospitals.

“If you take care of COVID offline … you can watch big bills,” said Karen Politz, a senior fellow at Kaiser.

Even insured patients who are hospitalized online can receive financial blows. There is no guarantee that every doctor treating this person is in their insurance network.

It can sometimes take months for hospital claims to be processed, so it’s too early to know how many patients are going through these cracks, said Matthew Eisenberg, an economist at the Johns Hopkins Bloomberg School of Public Health.

If a large bill does arrive, patients do not have to pay immediately. Ask questions first and check for errors.

Hospitals that have received federal money to support coronavirus-related expenses or lost revenue should not send so-called surprise bills to patients who receive offline care. Anyone who receives these bills should ask if the hospital has received this assistance.

Georgetown’s Corlette also noted that hospital billing departments are adapting to the handling of COVID-19 claims. Some may have used the wrong code or made another mistake.

“There are reasons why both the supplier and the insurer can say, ‘Well, now we’ve made a mistake,'” she said.

According to Szymanski, she has made more than 20 phone calls and emails in the past five months fighting the decision to cover care.

She finally made progress after contacting the state insurance department. Szymanski said state regulators helped her withdraw an additional $ 2,900 from the account and hoped to cover the rest.

In addition to fighting for a coverage decision or questioning a bill, patients should also seek help, said Elizabeth Benjamin, vice president of the New York City Public Services Society, which helps people deal with medical bills.

“It’s important to ask for financial help or to be forgiven for the co-payment in that single circumstance, because you’re in a narrower problem right now,” she said. “I think a lot of suppliers want to do the right thing.”

Benjamin said patients were disappointed at the start of the pandemic because hospital billing offices did not even answer the phone. She now sees a wave of cases where people are surprised by offline care bills.

“These are really complicated things,” she said. “It’s sad that our healthcare system requires people to be experts on how billing works and how they work.”

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Follow Tom Murphy on Twitter: @thpmurphy

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The Associated Press’s Department of Health and Science receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.




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