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August 4, 2020

Why the New York Times wants to see your patients' coronavirus bills

Daily Briefing

    When Debbie Krebs went to the hospital to get tested for the novel coronavirus, she thought her visit would be covered by insurance without out-of-pocket costs—but she ended up getting a surprise medical bill instead, Sarah Kliff reports for the New York Times' "The Upshot."

    2 ways hospitals can help Covid-19 patients with their bills (without suspending billing)

    A nearly $2,000 coronavirus bill

    When Krebs, a lawyer who lives in New Jersey, went to the ED at New Jersey's Valley Hospital in March with a cough and lung pain, she wanted to be tested for the coronavirus. Krebs said providers at the ED first conducted several tests to rule out other illnesses, and they then swabbed Krebs' nose.

    Krebs thought the provider was swabbing her nose to collect a sample for a coronavirus test. She told Kliff that she remembers the doctor telling her the swab for the test might make her feel like she had to sneeze. And one week later, a medical laboratory informed Krebs that her test for the coronavirus was negative, Kilff reports.

    Krebs thought she wouldn't have any out-of-pocket costs for the visit since she was tested and seeking care for a possible coronavirus infection. According to Kliff, the federal government has mandated that government-sponsored and many private health plans cover the costs of coronavirus testing and visits for the tests without cost-sharing requirements if coronavirus testing is deemed medically necessary.

    But Krebs later received a bill for her visit, which stated that she owed the hospital $1,980. She noticed the bill did not include a charge for a coronavirus test, however.

    "When I called the hospital, they said, 'You did not get a coronavirus test,'" Krebs told Kliff. "I told them I absolutely did."

    Kliff reports that she called the hospital to learn about Krebs' visit and, two days later, the hospital resubmitted its claim for Krebs' visit to her insurer—this time including a charge for a coronavirus test. Krebs' insurer, Aetna, then confirmed that she would not have to pay the charges for her visit.

    Josette Portalatin, an assistant VP of Valley Hospital, in an email to Krebs apologized and wrote that the hospital at the time was "trying to come up with extraordinary processes quickly to react to the many changes placed on all of us, including payer requirements of coverage."

    Krebs' case highlights a broader problem with billing for coronavirus care

    Krebs is one of many Americans to report receiving a surprise bill for coronavirus-related medical visits, according to Kliff.

    Kliff notes that she and her colleagues have reported on patients seeing charges for coronavirus tests that cost more than $2,000, as well as a patient receiving a $401,886 bill for treatment. And Kliff reports that, in a lot of these cases, patients expected the costs of their coronavirus tests and treatment would be covered by their health plans.

    But although the federal government has mandated that most health plans cover coronavirus tests and related costs without cost-sharing for members and that providers make their charges for coronavirus tests public, "[n]umerous doctor's offices and hospitals do not post the cash prices for their coronavirus tests," which can cost between $199 and $6,408, Kliff reports. In addition, some patients have reported that they've been charged co-payments for coronavirus testing, as some providers "have stuck to their regular billing habits," according to Kliff.

    "Billing offices may just be doing what they're used to—looking at your card, seeing that it says $30 co-pay and collecting it," Karen Pollitz, a senior fellow at the Kaiser Family Foundation (KFF), told Kliff. But that might not be intentional, Pollitz said. "The person at the front desk may not know you got a test. The protections aren't airtight."

    Further, in order for coronavirus testing and related care to qualify for the federally mandated coverage, a coronavirus test must be noted on a patients' visit receipt or claim—and that has resulted in a lot of billing challenges, Kliff reports. For instance, Kliff notes that, due to a nationwide shortage of coronavirus tests and supplies, some doctors aren't able to test patients for the virus and instead have to diagnose coronavirus infection through a process of elimination by testing patients for and ruling out other conditions. And as a result, since their patients' bills don't indicate that they've received a coronavirus test, patients in some instance have been responsible for the costs of their visits.

    Kao-Ping Chua, a pediatrician, told Kliff that, at America's previous peak of the epidemic in the spring, his health system required that patients seeking a coronavirus test undergo testing for other conditions, including a common cold and the flu, before being administered a coronavirus test, which were in short supply.

    "I had to tell my patients that, if the test I run first comes back positive and says you have the common cold, you'll have to pay for it. … But if you test negative, that allows you to get the [coronavirus] test, and that waives your cost sharing," he said.

    Overall, Kliff reports, "[t]he experiences of patients who had or suspected they might have Covid-19 show how hard it is to write different billing rules for a tiny sliver of the country's $3 trillion in health spending."

    Kliff wants patients' coronavirus bills—and providers' stories on how Covid-19 is changing their work

    Acknowledging the complexities around billing for coronavirus care, Kliff—who has been conducting investigations into surprise medical bills for about three years—now is calling on patients to submit their stories on surprise bills they received for coronavirus care to the Times.

    She writes, "Americans have been battling surprise coronavirus bills for nearly as long as they've been fighting the disease itself," and as she and her colleagues continue "explor[ing] how the [epidemic] is reshaping health care in the United States, [they] invite you to show [them] what you're being charged for testing and treatment of Covid-19, and other medical costs that you have incurred related to it." She adds, "Because health care providers keep their prices secret, your bills play a critical role in helping us understand how Americans are grappling with medical costs during the" epidemic.

    Kliff also encourages patients to submit stories about how access to care and providers charges in general have changed since the epidemic began.

    In addition, Kliff is asking providers to share their stories of how Covid-19 has changed the way they work with the Times. She writes, "In addition to drawing on your experiences to inform my stories, we hope to connect with you later, possibly with email updates or online gatherings, to talk about how the coronavirus is changing health care" (Kliff, "The Upshot," New York Times, 8/3; Kliff, New York Times, 8/3 [1]; Kliff, New York Times, 8/3 [2]).

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