Trump promised to pay for Covid care. But
patients with long-term symptoms see huge bills.
Doctors are discovering life-threatening and costly
long-term health effects ranging from kidney failure to heart and lung damage.
By SUSANNAH
LUTHI
06/24/2020
07:55 PM EDT
The Trump
administration’s pledge to protect Covid-19 patients from massive medical bills
is falling short for a growing number of survivors who experience long-term
complications from the virus.
Doctors are
discovering life-threatening and costly long-term health effects ranging from
kidney failure to heart and lung damage. That’s exposing a major gap in the
federal government’s strategy for ensuring patients won’t go broke because of a
coronavirus diagnosis.
Patients
with and without insurance have already been hit with staggering bills, despite
a White House promise to cover their costs, according to patient advocates.
That’s because health care providers and insurers are classifying some
complications as distinct from the virus during the billing process. The extent
of the problem is still not fully known due to the lag time in settling medical
claims.
Private
health insurers, including many the White House prodded to waive full treatment
costs for patients diagnosed with coronavirus, haven’t committed to extending
those generous coverage policies to patients dealing with virus-related
conditions weeks or months later. Some that only cover in-network care are
rejecting bills from out-of-network specialists.
"The
death toll, as devastating as it is, is a small part of the whole story,
because you don’t know what the disability toll is."
James DeLemos, chair in cardiology at the
University of Texas Southwestern Medical Center
Insurers
like Cigna are waiving costs for these post-viral health problems — but only as
long as the patients’ doctors explicitly link them to Covid-19 on their medical
bills. Patients whose doctors fail to may be exposed to staggering charges: One
woman reported getting at least $65,000 in bills for an eight-day stay in the
hospital for Covid-19 and complications that included a colon infection.
The payment
policies also may not help people who had coronavirus symptoms early during the
pandemic but couldn’t get tested — or who experienced symptoms mild enough not
to even try. The bills and ongoing cost of care for these individuals can be
massive if they develop heart inflammation, kidney disease, or other serious
problems that doctors have observed for months.
“The death
toll, as devastating as it is, is a small part of the whole story, because you
don’t know what the disability toll is,” said James DeLemos, chair in
cardiology at the University of Texas Southwestern Medical Center.
Health
providers eager for payment are lobbying the Trump administration to start
paying for uninsured patients’ post-coronavirus care using a hospital bailout
fund. Facilities that get paid can’t turn around and try to collect more money
from the patients.
But the
Health Resources and Services Administration that runs the fund says it will
only pay if Covid-19 is the patient’s primary diagnosis. Molly Smith, a vice
president at the American Hospital Association, calls the requirement “flawed,”
and warns the government won’t pay for a “significant” amount of coronavirus
treatment as a result.
A
spokesperson for the Department of Health and Human Services declined to say
whether the administration is talking to health plans about a solution. The
government hasn't issued guidance on billing for post-virus conditions, citing
ongoing ongoing research and the many unknowns about the long-term effects of
Covid-19.
A HRSA
spokesperson said as long as the program requirements are met, treatment of a
stroke or other complication will get covered — but reiterated that Covid-19
needs to be the primary diagnosis.
It will
take years to document the long-term effects of the novel coronavirus, but early
signs have been alarming. One study of hospitalized patients in Wuhan, China,
found that nearly 20 percent of those with confirmed cases suffered heart
injury.
Some of the
treatment costs worry patient advocates and policymakers. Charges for a six-day
hospital stay for a coronavirus patient with an underlying health condition or
complications average more than $74,000 according to FAIR Health, a nonprofit
that analyzes claims data, although commercial plans would pay an average of
just under $39,000 for the treatment. Cases with fewer complications would
still incur charges averaging more than $53,000 for a six-day stay.
The
consulting firm Avalere recently projected that a typical hospital stay for
coronavirus patients is nearly $23,500. But insurers still don’t have a clear
picture of potential long-term costs, especially if patients need long rehab
after weeks on ventilators, or dialysis if they suffer kidney failure.
“We still
don’t know the disease from the clinical side, we don’t know the complications
and we don’t know it on the claims side,” said one insurance lobbyist.
DeLemos
calls the range of post-viral problems a “desperate area,” in which very little
is known about what happens to survivors once they're discharged. The same goes
for the overwhelming majority of Covid-19 survivors who never were hospitalized
and don't know if they’ll experience long-term health effects.
“Some had a
mild lung condition and then got a very serious heart complication,” he said.
“The only thing I can say is that the most predictable thing about Covid is its
unpredictability.”
The dearth
of data makes policy-making difficult. Paul Auwaerter, clinical director of the
Division of Infectious Diseases at Johns Hopkins University, noted people who
were healthy before Covid-19 and are now suffering new health problems may
blame the virus for unrelated conditions. Only better data and analysis will
resolve questions.
“People
tend to anchor on the last thing that hit them, so as more time goes on, people
will turn to Covid, but it’s not always the answer,” he said.
Confirmed U.S. Cases: 2,381,369 | U.S. Deaths: 121,979
Meanwhile
advocates wary of costs being shifted on unsuspecting patients are watching for
all the ways complications will hit Americans during the pandemic.
“Having
done this for 25 years, when we hear the governors say, If you need health care
you can get it, it’s just not our experience,” said Michele Johnson, executive
director of the Tennessee Justice Center, referring to the White House promise
that all uninsured patients are covered. She noted that it's hard for many
patients to get through the door for medical treatment, including even Covid-19
testing, if they don't have coverage.
Cynthia
Fisher, founder of the nonprofit Patient Rights Advocate, lambasted insurers
and hospitals alike for the high medical bills she’s seen from Covid-19, noting
that health plans have been making money throughout the pandemic, since most
people put off going to their doctors but still are paying premiums. And
overall, a minority of Covid-19 patients are getting hospitalized with serious
problems.
“It’s just
the right thing to do to cover their care, because the insurance companies have
been prepaid for this, and yet they’re not actually covering the people who
have paid for coverage,” Fisher said. “We’re just seeing the insurers are
capitalizing on the pandemic.”
Meanwhile,
the existing pledges to cover people's treatment could end if the Trump
administration refuses to extend its public health emergency for the pandemic,
which is due to expire next month.
On Tuesday,
the administration gave health plans wide berth if they want to back out of
their pledges to fully cover coronavirus treatment once the emergencies are
lifted. Instead of the 60-day warning usually required to make policy changes,
health insurers can drop the enhanced benefits with “reasonable” notice, or
simply when the declaration expires if they've informed customers.
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