Patients complain about COVID-19 ‘hidden cost’

Twice in less than two months last year, Nancy Keator was surprised and angered by extra fees tacked onto her medical bills.

In November and again in December, the Westerville resident had to have X-rays (at different facilities), and each time, the bill contained a fee attributed to the COVID19 pandemic: One for $25 for “extra supplies, material and clinical staff ” and the other for $15 for additional cleaning.

Keator, 69, questioned the need for the charges (“Are you telling me you don’t normally clean between X-rays?” she asked), but what really got her was that neither facility told her about the fees ahead of time.

She only learned of them after getting the bill and discovering her insurance company did not pay them.

“The whole thing seemed to be to be taking advantage of a bad situation,” Keator said. “I feel they are unnecessarily gouging people.”

She is not the only one. The Ohio Attorney General’s office has fielded 173 COVID-related billing complaints, ranging from landlord-tenant rental disputes to fitness centers still charging fees despite the gym being closed.

Of those complaints, 24 involved medical office fees. The Ohio Department of Insurance has had only one such complaint, a spokesman said.

To Keator’s first complaint, about the necessity of extra charges, medical officials say they help cover legitimate extra costs.

An American Dental Association (ADA) survey in

December found that dentists’ costs for personal protective equipment (PPE) have roughly tripled since the start of the pandemic.

Todd Baker, chief executive officer of the Ohio State Medical Association, said that in addition to the “hard dollar” cost of purchasing more PPE and cleaning supplies, doctors and dentists also incur a “soft dollar cost” for additional time and personnel needed to meet new safety protocols.

“For example, now we need someone by the front door doing temperature checks,” Baker said. “We do more screenings, calling everyone the morning of their appointment to see if they have any symptoms. We do additional cleaning.

“Those are all hidden costs that every industry is struggling with.”

Baker and others, though, agree with Keator on her second point: That providers should be upfront in telling patients about the additional fees.

“Both the ADA and the Ohio Dental Association have recommended to their members that if you have to raise your fees or charge some sort of PPE fees, it’s especially important to tell the patient in advance,” said David Owsiany, executive director of the Ohio Dental Association. “You should explain to them that costs have gone up, we hope temporarily, and we have to recoup those costs to keep the doors open.

“I think almost all complaints could probably be avoided had there been better communication. Maybe, in a busy dental practice, they didn’t explain it well enough.”

Steve Wagner is executive director of UHCAN Ohio, a Columbus-based nonprofit organization that advocates for consumers on health care issues.

“It’s somewhat predictable that this would happen,” Wagner said. “Medical costs are relatively opaque to the consumer. You don’t find out about them until afterward, and we don’t think that’s right.

“What other product do you purchase and then later they say, ‘OK, here’s the bill?’”

Baker said the state medical association is calling for insurance companies to cover the COVID-19-related fees. A billing code has been created specifically for the fees, he said.

“To my knowledge, no insurance companies are paying for it right now,” he said. “We are in the advocacy stage of pushing for it at this point.”

A spokeswoman for the Washington, D.C.-based trade industry group America’s Health Insurance Plans said she did have any “industry-wide information on practices regarding that billed fee in particular.”

She sent links to information on what various insurance companies have done to help consumers in the pandemic, such as waiving costs for COVID-19 testing and treatment, and waiving costs for telehealth services.

That didn’t help Keator, though. She ended up resolving the issue herself.

She said after calling both offices and complaining about the extra fees, both charges eventually were cancelled.

“I told them, ‘I’m not paying this. I’m paying what the insurance company says I should pay,’” Keator said.