Could COVID-19 Jeopardize America’s Financial Well-Being, as well as its Physical Health?

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Original story posted on: March 16, 2020

A cautionary tale about the virus and its potential financial impact on patients.

Here are several direct and indirect financial hits patients could see that may not be waived or covered benefit during the coronavirus pandemic.  

While the Centers for Disease Control and Prevention (CDC) isn't billing for coronavirus testing, and due to swift government action, many of the COVID-19 testing performed by independent practices and/or hospitals (via lab tests) won’t come with a share of cost for the patient, patients still have to be aware of some hidden costs that they will likely be on the hook for, such as for the trip to the emergency room or urgent care. 

If a patient contracts the virus or experiences severe symptoms warranting an out-of-network emergency room visit, procedures related to coronavirus testing and treatment could range anywhere from $341 to $1,205, according to Modern Healthcare. Also, remember that deductibles for private and commercial insurance have risen almost 500 percent in the past few years, when the Patient Protection and Affordable Care Act created insurance exchanges and mandated that Americans become insured. The current average annual deductible for Americans who get health insurance on their own is $5,500, while the deductible for people who are offered plans through their employer is around $1,500-$1,800. Since the coronavirus is spreading early in the year, many workers may not have hit their deductibles yet.

Americans also may be affected by surprise billing, which occurs when a patient receives care at an in-network facility, but receives a higher bill than expected because a physician who treated them or handled their tests may be out of network. Surprise billing hits 1 in 6 emergency room or hospital patients, on average, according to Becker’s Hospital Review. Remember, the federal surprise billing legislation only relates to facility charges, not physician fees. So if a bill from an out-of-network physician shows up at some point, it is the patient’s financial responsibility.

A recent American Medical Association (AMA) survey suggested that more than 25 percent of U.S. adults have delayed getting medical care for financial reasons.

A California resident and personal friend of mine was charged $4,100 for coronavirus-related testing and treatment in early February. She received a bill that included charges of $2,440 for virus and flu testing, $1,050 for an ER visit, and another $610 for miscellaneous hospital and/or physician charges. Since she is an otherwise healthy person, she had not met her deductible this year yet, and realized this 21 days later, when she received a bill from the hospital. So now she is stuck with these out-of-pocket costs with no government or insurance company relief in sight, since it was determined that she had only an URI, and was not positive for COVID-19. Suspected coronavirus patients do not have any recourse to offset the expense of testing. Even though after this patient called the ER and explained her symptoms, she was told to come in immediately for testing. And she still may be getting another bill from the physician’s office.

As a healthcare professional, just be mindful of all of the information that is currently being posted out there on “financial relief” for patients, when it comes to the COVID-19 pandemic. Not all of this information is accurate, as it pertains to how care will be funneled to patients who will see large out-of-pocket expenses due to testing, hospital visits and stays, and physician charges. There has not yet been disseminated a clear point A-to-point B guide illustrating just who will get the relief, and who will not.

So before you have financial conversations with your patients on what their share of cost will be, make sure it is accurate, informed, and in writing.

Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS,  ACS-CA, SCP-CA, QMGC, QMCRC

Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC, is a healthcare coding consultant, educator, and auditor with more than 30 years of experience. Terry is a past member of the national advisory board for AAPC, past chair of the AAPCCA, and an AAPC national and regional conference educator. Terry is the author of several coding and reimbursement publications, as well as a practice auditor for multiple specialty practices around the country. Her coding and reimbursement specialties include cardiology, peripheral cardiology, gastroenterology, E&M auditing, orthopedics, general surgery, neurology, interventional radiology, and telehealth/telemedicine. Terry is a member of the ICD10monitor editorial board and a popular panelist on Talk Ten Tuesdays.

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