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COVID Payment Burdens Echo How U.S. Health System Routinely Fails Patients

Covid Killed His Father. Then Came $1 Million in Medical Bills., NY Times, May 21, 2021, By Sarah Kliff

Insurers and Congress wrote rules to protect coronavirus patients, but the bills came anyway, leaving some mired in debt.

“People think there is some relief program for medical bills for coronavirus patients,” said Jennifer Miller, a psychologist near Milwaukee who is working with a lawyer to challenge thousands in outstanding debt from two emergency room visits last year. “It just doesn’t exist.”

Many large health plans wrote special rules, waiving copayments and deductibles for coronavirus hospitalizations. When doctors and hospitals accepted bailout funds, Congress barred them from “balance-billing” patients — the practice of seeking additional payment beyond what the insurer has paid.

Interviews with more than a dozen patients suggest those efforts have fallen short. Some with private insurance are bearing the costs of their coronavirus treatments, and the bills can stretch into the tens of thousands of dollars…

Some hospitals are not complying with the ban on balance billing. Some are incorrectly coding visits, meaning the special coronavirus protections that insurers put in place are not applied. Others are going after debts of patients who died from the virus, pursuing estates that would otherwise go to family members…

Coronavirus patients face significant direct costs: the money pulled out of savings and retirement accounts to pay doctors and hospitals. Many are also struggling with indirect costs, like the hours spent calling providers and insurers to sort out what is actually owed, and the mental strain of worrying about how to pay.

Ms. Miller, like many other patients, described trying to sort out her complicated medical charges — in her case in color-coded folders — while also battling the mental “brain fog” that affects as many as half of coronavirus long-haul patients.

“I have a Ph.D., but this is beyond my abilities,” she said. “I haven’t even begun to look at my 2021 bills because we’re still dealing with 2020 bills. When the bills come nonstop, you can only deal with so much.”

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Comment by Jim Kahn

COVID care was supposed to be the exception: amidst a pandemic, insurers agreed to cover all medical care related to this infection, with no cost-sharing for patients. But it didn’t happen. These interviews in the New York Times show how patients and their surviving family members were saddled with tens of thousands of dollars in cost-sharing, and many hundreds of hours at the kitchen table and on the phone trying to sort out the deluge of bills, long after their loved one was gone.

What went wrong? The short answer is that our system is so inherently complex and dysfunctional that it couldn’t pull itself together, even in an emergency.

Here are the sordid details: 

Our system relies extensively on cost-sharing (deductibles, copays). That means that forgiving the cost-sharing burden is an issue – not so in other wealthy countries. 

Second, it’s complicated to manage these complex financial rules, leading to huge administrative burdens for insurers, providers, and… patients and families.

Third, the insurers “agreed” to cover all COVID care. No force of law.

Fourth, a catch: the offer to forego cost-sharing depends on a diagnostic code for COVID. What if somebody has multiple medical problems – as is true for many of the sickest with COVID? If the COVID code isn’t prominently noted, that person loses out.

And, finally, preoccupation with profit. Another recent New York Times story describes how hospital chains used federal COVID relief funds to grow their clinical empires and thus profits. Shareholders win, people lose.

When will we learn? We must commit to universal, equitable high quality care – healthcare justice – combined with the efficiency of simplicity. What’s that called? Single payer.