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For Covid-19 long-haulers, the symptoms (and the bills) keep adding up

As some Covid-19 survivors tackle long-term complications from the disease, they're discovering a new obstacle on the already long list of challenges they face: the cost of their ongoing medical care.

How Covid-19 will impact the financial outlook for the health care industry

Covid-19 long-haulers could face high health care costs, experts warn

While there aren't any precise numbers, researchers estimate that thousands of Covid-19 patients are so-called "long-haulers," or patients who've seemingly recovered from their coronavirus infections but experience symptoms of Covid-19—such as fatigue, shortness of breath, and neurological issues—for weeks or months after their initial diagnosis. For instance, a study by Gemelli University Hospital in Rome found that 87% of Covid-19 patients reported experiencing at least one lingering symptom two months after they were diagnosed.

And the problem isn't limited to patients who were hospitalized for severe cases of Covid-19. According to a CDC survey, about one-third of 270 Covid-19 patients who were not hospitalized reported experiencing Covid-19 symptoms up to three months after diagnosis.

As these individuals seek ongoing medical care for their symptoms, health care experts warn that these patients may face high health care costs to manage the disease. For example, 41-year-old Tricia Sales—who is still experiencing dizziness, nausea, and numbness in her hands and feet five months after her initial coronavirus infection in March—faces more than $100,000 in medical bills, the Wall Street Journal reports.

Sales, who initially was uninsured, has sought hospital care 15 times due to her lingering symptoms. She's also visited multiple specialists and has undergone a spinal tap and imaging scans. Sales has now qualified for a Medicaid program for patients with a large amount of medical expenses. Her Covid-19 symptoms have left her "too ill" to do much other than try to get better, the Journal reports.

Separately, Joy Nelson, a 63-year old who has had Covid-19 symptoms since March, said she's foregoing treatment due to the costs. Nelson, who has a $6,800 annual deductible under her health plan, said, "I have been on the verge of calling 911 many times over the last few months, but cannot afford the hospital bill."

And in an even more challenging position are long-haul patients who were never formally diagnosed with Covid-19, although they suspect they were infected with the coronavirus.

For example, when Jenifer Johnston, a 40-year-old in Washington, first fell ill with Covid-19 symptoms, she was told there weren't a sufficient number of tests available to screen her for the coronavirus. Johnston had been ill for two months before a provider acknowledged that she likely was experiencing post-Covid-19 complications.

Johnston, who has a $2,000 deductible under health plan, has used up her employer's Family and Medical Leave and is currently living off her savings because she is still too ill to work. She says she can't afford the out-of-network specialist she was referred to for further care, the Journal reports.

Total costs could take years to calculate

According to health care experts, it could be years before the costs of care for Covid-19 patients will be fully calculated. "On a global level, nobody knows how many will still need checks and treatment in three months, six months, a year," said Marco Rizzi from the Giovanni XXIII Hospital in Italy.

Bruce Lee from the City University of New York Public School of Health estimated that, if 20% of Americans contract the novel coronavirus, one-year post-hospitalization costs would be more than $50 billion—and that's without factoring in long-term care.

Lee estimated the one-year cost for a Covid-19 patient after discharge from the hospital could add up to $4,000 due to lingering health issues such as acute respiratory distress syndrome and sepsis—although that estimate doesn't factor in heart or kidney damage, or other potential complications related to the coronavirus. Lee projects that even patients who were not hospitalized will likely see an average one-year cost of $1,000.

According to the Journal, these costs would likely be due to the effects Covid-19 will have on patients' organs, such as the heart, lungs, and kidneys, which could require scans, ultrasounds, and other costly procedures. For instance, just one computer-imaging scan can cost up to $5,000, while a complex echocardiogram can cost up to $2,000, the Journal reports.

Experts say expanding insurance coverage could be necessary to address financial burden of Covid-19

But researchers say Covid-19 patients won't be the only ones strained by their medical costs. According to the Journal, the cost of care for long-haul patients eventually could burden the U.S. health care system and economy by overloading safety-net programs.

Zijian Chen, director of Mount Sinai Health System's Center for Post-Covid Care, voiced concerns about how the disease will affect the economy, as well as public safety-net programs and individual patients. "We need to mobilize the medical community as a whole, and that's going to cost money," Chen said. "It affects patients' ability to work, and that has major implications as well for the economy."

During the early days of America's coronavirus epidemic, Congress attempted to address the potential financial burden of Covid-19 by reimbursing hospitals at Medicare rates for treating uninsured Covid-19 patients and making coronavirus tests available to Americans at no cost. Many insurers also waived out-of-pocket Covid-19 treatment costs for their members.

But some experts say the federal reimbursements won't be enough. HHS had reimbursed more than $347 million in treatment claims by July 30, but a report from Avalere projects that Coivd-19 inpatient hospitalization costs will reach $17 billion this year, the Journal reports.

And those costs don't account for long-term Covid-19 patients, many of whom are already filing for disability and applying for Medicaid, health advocates said. According to the Avalere report, federal and state Medicaid costs for Covid-19 hospital expenses could hit $780 million in 2020.

In addition, long-haulers' extra care costs could result in increased health insurance premiums for the more than 50% of Americans who have private health plans. In fact, according to the Kaiser Family Foundation, some health plans already have raised 2021 premiums by up to 8% due to Covid-19 costs. KFF said premiums for 2021 are rising by an average of 5%—which is significantly higher than the average increase in wages and more than twice the rate of inflation.

Ultimately, Families USA said the financial burden associated with long-haul Covid-19 patients highlights holes in U.S. health insurance coverage, especially since at least 5.4 million Americans became unemployed and uninsured between February and May. And, as a result, some experts are calling for expanded health coverage to address the issue.

Tom Nickels, EVP of government relations and public policy at the American Hospital Association, said, "There is more that needs to be done. The answer is that people need to have coverage" (Armour, Wall Street Journal, 8/25; Humer et al., Reuters, 8/3; Sloan et al., Avalere, 6/19).






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