Insurers restore big bills for COVID-19 treatment
Jamie Azar left a rehab hospital in Tennessee last week with the help of a walker after spending the entire month of August in the ICU and on a ventilator. She had received a shot of the Johnson & Johnson vaccine in mid-July but tested positive for the coronavirus within 11 days and nearly died.
Now Azar, who earns about $36,000 a year as the director of a preschool at a Baptist church in Georgia, is facing thousands of dollars in medical expenses that she can’t afford.
“I’m very thankful to be home. I am still weak. And I’m just waiting for the bills to come in to know what to do with them,” she said.
In 2020, as the pandemic took hold, U.S. health insurance companies declared they would cover 100 percent of the costs for COVID treatment, waiving co-pays and expensive deductibles for hospital stays that frequently range into the hundreds of thousands of dollars.
But this year, most insurers have reinstated co-pays and deductibles for COVID patients, in many cases even before vaccines became widely available.
Now the financial burden of COVID is falling unevenly on patients across the country, varying widely by health care plan and geography, according to a survey of the two largest health plans in every state by the nonprofit and nonpartisan Kaiser Family Foundation.
If you’re fortunate enough to live in Vermont or New Mexico, for instance, state mandates require insurance companies to cover 100 percent of treatment. But most Americans with COVID are now exposed to business-as-usual medical billing and insurance practices.
(Insurers continue to waive costs associated with vaccinations and testing, a pandemic benefit the federal government requires.)
A widow with no children, Azar, 57, is part of the unlucky majority.
The carrier for her employee health insurance, UnitedHealthcare, reinstated patient cost-sharing Jan. 31. That means, because she got sick months later, she could be on the hook for $5,500 in deductibles, copays and out-of-network charges for her care in a Georgia hospital near her home, including her ICU stay, according to estimates by her family. They anticipate she could face another $5,500 in uncovered expenses next year as her recovery continues.
“We still don’t know where the numbers will land because the system makes the family wait for the bills,” said Azar’s sister, Rebecca Straub.
UnitedHealthcare declined to comment specifically about Azar’s situation.
In general, a person with Azar’s type of plan would have an in-network deductible of $1,500 and an in-network out-of-pocket maximum of $4,000, said UnitedHealthcare spokeswoman Tracey Lempner in an email.
The charges Azar anticipates would be budgetcrushers, Straub said. Her relatives are seeking help from the public on a nonprofit patient-fundraising website called Help Hope Live, which says it verifies the circumstances of each patient’s condition with medical providers.
Last year, according to the Kaiser Family Foundation, 88 percent of people covered by private insurance had their co-pays and deductibles for COVID treatment waived. By August 2021, only 28 percent of the two largest plans in each state and the District of Columbia still had the waivers in place, and another 10 percent planned to phase them out by the end of October, the Kaiser survey found. Its survey this year of employer-sponsored plans reflected similar patterns.
America’s Health Insurance Plans, the industry’s lobbying and trade group, said insurance companies began to reinstate cost-sharing for COVID treatment as vaccines became available and in recognition that the coronavirus will be an ongoing health challenge.
“After a year and a half, it’s pretty clear that COVID is here to stay, that this is a continuing health condition,” AHIP spokesman David Allen said. “When it comes to treatment, we’re looking at it like we would treat any other health condition.”
The reintroduction of cost-sharing mainly affects people with private or employer-based insurance. Patients with no insurance can have 100 percent of their expenses covered by the federal government, under a special program set up by the government for the pandemic, with hospitals reimbursed for care at Medicare rates.
COVID patients with Medicaid, the government plan for lower-income people that is paid for by states and the federal government, continue to be protected from cost-sharing, insurance specialists said. Patients on Medicare, the federal plan for the elderly, could face out-of-pocket costs if they do not have supplemental insurance.
Nationally, COVID hospitalizations under insurance contracts on average cost $29,000, or $156,000 for a patient with oxygen levels so low that they require a ventilator and ICU treatment, according to data gathered by the national independent nonprofit FAIR Health.