When Osmel Martinez Azcue started experiencing flu-like symptoms after coming home from China last month, he sought medical attention to see if he might have the novel coronavirus—but his limited health insurance plan may leave him on the hook for thousands of dollars, Ben Conarck reports for the Miami Herald.
Reports of the new coronavirus first surfaced in early December 2019 in Wuhan, China. According to the World Health Organization (WHO), the main symptoms of the virus are fever and lesions in both lungs. Some patients also have reported difficulty breathing, WHO said. Officials have named the disease COVID-19.
As of Wednesday, officials reported more than 81,900 cases of the virus globally, with most of those cases occurring in mainland China. Officials said as of Wednesday there have been more than 2,770 reported deaths linked to the virus, and all but 55 of the deaths occurred in mainland China.
The price of getting tested
Upon returning from a work trip to China last month, Azcue noticed he was developing flu-like symptoms. While Azcue usually would handle flu-like symptoms with over-the-counter medicines, given his travel history, he sought a test for COVID-19, Conarck reports.
Azcue went to Jackson Memorial Hospital and was sent to a "closed-off room," Conarck reports. Providers who treated him wore protective clothing and sprayed disinfectant under the door before they entered.
When Azcue described his circumstances, the care team initially said he needed a CT scan to be tested for the new coronavirus. However, Azcue worried about the cost, given his limited health insurance plan, and instead asked that he first be tested for flu.
Azcue recalled he told the care team, "Let's start with the blood test, and if I test positive, just discharge me."
So, Azcue got a flu test, which confirmed he had the flu, not the novel coronavirus. After the test, he was discharged.
However, about two weeks after the visit, Azcue's insurance company, National General Insurance, sent him a notice of a claim for the visit for about $3,270, Conarck reports. In addition, officials with Jackson Health, which runs Jackson Memorial, said Azcue will receive more bills from the companies that staff physicians at Jackson Memorial. Jackson Health said it did not know how much those bills would total.
Hospital officials for Jackson told the Herald that Azcue would be on the hook for only $1,400 of the $3,270 bill. But because Azcue is covered under a health plan that does not comply with the Affordable Care Act (ACA), it's unclear whether he will be responsible for more of that bill.
How so-called 'junk plans' (don't) work
Azcue's employer doesn't offer insurance, so he'd previously purchased an ACA-compliant plan for himself. However, when the premiums increased to about $400 a month when his full year salary as counted, Azcue dropped the plan, Conarck reports. To save money, he switched to a National General plan that isn't ACA compliant, and he now pays about $180 in monthly premiums.
These plans, often referred to as "junk plans" because of their narrow coverage, returned to the market after the Trump administration in 2018 rolled back certain ACA regulations, Conarck reports. Under the Trump administration's rules, the plans are not required to adhere to many of the ACA's provisions, including the law's requirement that plans cover pre-existing conditions, Sabrina Corlette, a Georgetown University professor and co-director of the Center on Health Insurance Reforms, said.
Corlette explained that it's not uncommon for these plans to ask consumers for three years of medical records to prove their illness wasn't a pre-existing condition. "That's the critical difference between [Affordable Care Act] plans and junk plans," Corlette said. "[Junk plans] will not cover preexisting conditions."
And that appears to be the route National General is taking. Azcue said National General told him he would have to provide documentation in the form of three years of medical records to prove that the illness that sent him to the hospital wasn't a pre-existing condition.
National General Insurance did not immediately respond to the Herald's request for comment.
The public health concern
Public health experts say the situation raises concerns about whether barriers, such as access and affordability, to getting screened for the new coronavirus will prevent others from seeking proper care.
"When someone has flu-like symptoms, you want them to … seek medical care," Corlette said. "If they have one of these junk plans and they know they might be on the hook for more than they can afford to seek that care, a lot of them just won't, and that is a public health concern." She added, "The idea that [the insurer] would have to comb through three years of his records just to determine if the flu was a preexisting condition is just crazy" (Conarck, Miami Herald, 2/24; Yeung, CNN, 2/26; Lai et al., New York Times, 2/26).