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COVID-19 leads to staggering medical bills whether you recover or not

Insurance leaves payment gaps and big bills
COVID-19 coronavirus hospital nurse
Posted at 5:29 AM, Feb 18, 2021
and last updated 2021-02-18 18:14:15-05

Casey and Savannah Gray are thankful to be sitting next to each other, alive.

Both were diagnosed with COVID-19 over the summer. Casey’s battle landed him in a hospital for about 75 days, most spent in the ICU, 50 of them under sedation, he said.

“I mean I almost died. I was on double life support and almost didn’t make it,” he said.

Yet he survived, giving thanks to the medical staff, friends, family and God after he was released.

“It was probably the hardest thing either of us had ever gone through. And hopefully will ever go through,” Casey, 28, said.

But months later, the Largo family’s journey still continues.

“There’s a lasting impact that it has. Like there’s still pieces that we’re trying to put back together and pick up even now,” Savannah, 26, said.

Physically, Casey said he still goes to physical therapy and can’t feel his foot. Emotionally, they said it’s taken a toll on mental health. And financially, they are feeling the effects of the cost of healthcare.

“The bills they keep coming” Savannah said, estimating 300 medical insurance claims filed for Casey related to COVID-19.

One document, an itemization of hospital services, shows the total amount of care before adjustments was a staggering $3.4 million. Of that, nearly $900,000 was deemed the total amount for hospital services. But after discounts and insurance, the Grays said their responsibility is about $9,000.

Still a hefty price tag for Savannah, a teacher, and Casey, a youth minister.

The Grays said they had good insurance and a community supporting them. Friends and family started a GoFundme during Casey’s hospital stay to help pay bills when he got out of the hospital, which they said helped. It raised nearly $12,000.

Without the generosity of friends and family, they wouldn’t have been able to pay the bill, Savannah said. “Our community one hundred percent came alongside us and completely supported us and they’ve continued to be a blessing.”

Widespread problem

They’re not alone, though.

A quick search of GoFundme reveals others the community is helping, too. The organization said a little more than 3 percent of pandemic-related fundraisers addressed medical needs between March and August.

The national, independent non-profit FAIR Health analyzed private insurance claims, and in part looked at the cost of hospitalization. According to its brief, ‘Key Characteristics of COVID-19 Patients,’ released in July, it found the median estimated allowed amount can range from about $17,000 to $24,000 depending on age group. It notes the cost of COVID-19 hospitalization is still a subject of debate, though.

“Unaffordable medical bills have long been a problem and COVID just kind of brings that home for a new set of families lately,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation.

Pollitz said a hospital charge that hits a deductible can still hurt for some families. According to the Kaiser Family Foundation, the average family deductible was $3,632 and the average single deductible was $1,993 in Florida in 2019.

“Most people with private insurance are in high deductible health plans. So we estimate on average people could be out of pocket for you know well over $1,000 for a COVID hospital stay. If you’re really seriously ill and need ventilator support that hospital bill can run up you know above $90,000. So you know getting seriously ill with COVID can be seriously, seriously expensive,” Pollitz said.

The Commonwealth Fund found in its biennial health insurance survey found that in the first half of 2020, more than 40 percent of working-age adults didn’t have stable health insurance coverage. A quarter with adequate coverage still reported medical bill problems or debt in the past year. They didn’t find statistically significant changes from the last time it was conducted in 2018.

“Even small amounts of money can be very difficult for people to pay off particularly if it’s unexpected,” said Sara Collins, the Vice President for healthcare coverage and access at The Commonwealth Fund.

Collins said what people pay for any illness can vary depending on someone’s health plan, deductible levels and whether the insurance is through an employer.

“Most insurers have waived copays and co-insurance for COVID treatment and they’ve done that from the beginning of the pandemic and most of them are continuing to do that,” she said.

The caveat: employers who are self-insured. In those companies’ plans the employer assumes the risk. “So we don’t know the extent of cost-sharing has been waived in those kinds of plans,” she said.

A Kaiser Family Foundation analysis of insurer responses to America’s Health Insurance Plans (AHIP) in November found 88 percent of enrollees were in a plan that waived out of pocket costs for COVID-19 treatment at some point during the pandemic. Of those, the organization’s analysis found 18 percent are in plans where the waiver has expired. It also notes most waivers apply to COVID-19 treatment received from in-network sources.

Steven G. Ullmann, Ph.D., director at the Center of Health Management and Policy at the University of Miami, noted the ramifications of COVID-19 can impact patients, insurance companies, state budgets and federal budgets.

“As patients are getting ill, especially for the chronic disease processes, the policies have not really addressed those issues. They’ve addressed again, the issues of the ICU’s, the intensive care units, and the ventilators and the government sort of assuring hospitals they’ll pick up part of the cost if the patient cannot pay,” said Ullmann of outpatient care, noting someone will have to pay the part of the bill they’re liable for in their insurance coverage.

A federal fund through the Health Resources and Service Administration, funded in part through the CARES Act, allows providers to file claims for reimbursement for those who received COVID19 treatment and are uninsured. In turn, the provider must agree not to bill the patient for the portion of the bill not picked up by the government. The patient’s primary diagnosis must primarily be for COVID-19, except for pregnancy when it may be secondary.

“There’s a lot of COVID relief out there for the businesses,” Samantha Dammer, a Tampa bankruptcy attorney said. But for consumers there’s really nothing that’s earmarked that could give them some sort of reassurance. So some of them may end up having to file bankruptcy just to get rid of that debt.”

Dammer said medical debts, for the most part can be discharged if someone files for bankruptcy. She has yet to have anyone turn to her solely because of medical debt, but she said for some clients COVID-19 “was the proverbial straw.”

“This is the straw, the proverbial straw, where they just have to get a fresh start from all this, it’s been a rough year,” she said.

So what recourse is there if someone is struggling with a bill?

If the person is uninsured, they can ask whoever they owe to submit the claim to the provider relief fund, Pollitz said. But if a person is underinsured and hit with a high deductible, “all you do is really ask kind of nicely … would they please forgive some of it” or put you on an extended payment plan, she said.

Some hospitals have programs to help those facing financial difficulties and to navigate the billing processes. (Information on financial assistance policies are available here: BayCare, Tampa General Hospital , AdventHealth, Sarasota Memorial Healthcare System, HCA Healthcare )

“While in the hospital, our caregivers encourage patients to focus on their recovery journey. After discharge, patients should contact us directly with any questions about their bill. Our experts can assist patients in understanding their bill, the billing process, what their insurance provider is covering and advise the patient if they qualify for financial assistance or other discounts,” stated Largo Medical Center.

The hospital opened a hotline to help patients who have lost their jobs understand their insurance options.

And there are nonprofit agencies looking for ways to help, too.

“COVID 19 has made this situation, medical debt, just so much worse. It both has the economic impact where people don’t have the financial means to pay medical bills, colliding with a very much need for healthcare,” said Allison Sesso, the executive director of the nonprofit RIP Medical Debt. The organization buys medical debt in bulk and then absolves the patients of the debt.. “So the pandemic has been kind of the perfect storm if you will to really aggravate a really bad problem and making it much, much worse.”

Sasso said they haven’t yet purchased COVID-19 medical debt, because it has yet to show up on the debt market..

“But we’re looking for it,” she said, in order to understand the impact the pandemic is having on medical debt in general.

The HealthWell Foundation is a national nonprofit that works to bridge the gap between insurance and the cost of prescription medications.

“There is a really strong profound need and Florida in particular has always been one of the most prevalent states that we service in the country,” said Alan Klein, the organization’s chief development officer.

HealthWell has opened several funds in response to the pandemic, including an insurance premium fund to help workers laid off or furloughed as a result of the pandemic. And they previously opened a fund to help with medication and food delivery. So far, HealthWell says it has helped more than 9,000 families through their COVID-19 relief funds.

And recently the organization opened up a COVID-19 behavioral health fund for frontline workers.

More than financial

For some families, the cost of COVID-19 isn’t just financial.

Ashley Pelose didn’t expect the virus to hit her family the way it did.

Despite taking precautions, she said, her 55-year old father with no pre-existing conditions still fell ill and was in the hospital for more than a month before passing away.

Her dad Frank Polose Jr., worked for 27 years as a mechanic and “loved the beach, loved to have a good time, always was super family-oriented," Ashley said.

“Me at 27 never thought that I would lose my dad let alone to a virus that people make fun of, think is fake, just talk very down about, but it’s a real thing.”

Like others, Ashley turned to her community for help through a GoFundme setup when her father was hospitalized. She also received support through her softball team, which made shirts with his initials.

“Thankfully we had life insurance, we had the Gofundme, but just the stress of that alone was a lot to deal with,” she said.

Ashley said the cost of care totaled more than $500,000. But after insurance, she said her family was responsible for his out-of-pocket medical expenses of $6,000, and about $15,000 for his funeral.

“It was super stressful. We all have full-time jobs and we’re trying to grieve and you know the loss of our dad,” she said. “And at the same time we’re trying to take care of bills and all this stuff and it doesn’t allow you time to properly grieve.”