Ethan Welty for KHN
From late March to April, Timothy Regan had several severe coughing attacks a day that often made him short of breath. He also regularly had a low grade fever.
Wondering if he had COVID-19, Regan called a nurse hotline run by Denver Health, a large public health system in his city. A nurse listened to him describe his symptoms and told him to go immediately to the emergency care facility in the hospital system.
When he arrived at Denver Health – where the emergency room and the emergency care center are located side by side at his main downtown location – a nurse referred him to the emergency room after noting a pain among his symptoms.
Regan was seen quickly and received a chest X-ray and an electrocardiogram, known as an ECG, to check his lungs and heart. Both were normal.
A doctor prescribed an inhaler to help him breathe and told him that he might have bronchitis. The doctor said he should assume he had COVID-19 and that he should be quarantined at home for two weeks.
At the time, on April 3, Denver Health reserved COVID-19 tests for sicker patients. Two hours after arriving at the hospital, Regan was back home. His longest wait was to fill his inhaler prescription.
Regan was not concerned about his own health. His wife Elissa, who is expecting their second child in August, and their 1-year-old son, Finn, also felt sick with symptoms like COVID-19 in April. “Nothing terrible but enough to worry about,” he said.
Regan, who is an appraiser for a construction company, worked from home throughout his illness – including quarantine. (Construction in Colorado and many states has been viewed as a vital business and has continued to operate.) Regan said he was worried about taking a day off and losing his job.
“I thought I should make as much money as I could in case we all had to be hospitalized,” he said. “All I could do was continue working in the hope that everything would be fine. “
In a few weeks, the whole family was fine. “We were lucky,” said Elissa.
Then the invoice arrived.
The patient: Timothy Regan, 40, an appraiser for a construction company. The family has health insurance through Elissa’s work with a non-profit organization in Denver.
Total invoice: Denver Health billed Regan $ 3,278 for the emergency room visit. His insurer paid $ 1,042, which leaves him $ 2,236 to pay based on his network deductible of $ 3,500. Most of the bill was overhead of $ 2,921.
Service provider: Denver Health, a large public health system
Medical service: Regan was evaluated in the emergency room for COVID-19 symptoms, including severe cough, fever and chest pain. He underwent several tests to check his heart and lungs, prescribed an inhaler and returned home.
Which give: When patients use hospital emergency rooms – even for short visits with few tests – it is not uncommon for them to be charged thousands of dollars, regardless of the severity of the treatment received. Hospitals say the high costs stem from the need to staff 24-hour emergency workers and keep rescue equipment up to date.
Denver Health coded Timothy’s emergency room visit as level 4 – the second highest and the second most expensive – on a 5-point scale. The other items on his bill were $ 225 for the EKG, $ 126 for the chest x-ray, and $ 6 for his albuterol inhaler, a drug that quickly relieves breathing problems.
The Regans knew they had a high deductible, and they tried to avoid unnecessary use of the emergency. But with doctors’ offices not seeing patients with COVID-19 symptoms in April, Timothy said he had no choice when Denver Health directed him first to his urgent care and then to his emergencies. “I felt bad, but I have been dealing with it for a while,” he said.
Elissa said they strive to do everything according to the book, including using a health care provider in their plan network.
“We did not expect to be hit by such a huge bill for the visit,” said Elissa. “We had intentionally called the nurse’s line to try to be responsible, but it didn’t work. “
In an effort to remove barriers preventing people from being tested and evaluated for COVID-19, UnitedHealthcare is one of many insurers who have announced that they will be waiving cost sharing for visits and treatments related to COVID testing -19. But it is not known how many people who had symptoms of COVID-19 but were not tested when tests were scarce were billed as were Regans.
Resolution: A Denver Health spokesperson said that Regan was not tested for COVID-19 because it was not admitted and had no risk factors such as diabetes, heart disease or asthma. He was not presented as a COVID-19 patient because he was not tested for the virus. The medical center has since expanded its testing capacity, the spokesman said.
UnitedHealthcare officials have reviewed Regan’s case at the request of Kaiser Health News. Based on Regan’s symptoms and the tests performed, Denver Health should have billed them using a COVID-19 billing code, said an insurer spokesperson. “We have restated Mr. Regan’s initial requests after examining the services he has received,” said a spokesperson for UnitedHealthcare. “Any cost sharing for this visit has been canceled. “
Ethan Welty for KHN
The Regans said they were delighted with the CSU’s decision.
“This is wonderful news,” said Elissa when she heard from a KHN reporter that the CSU would waive their fees. “We are very grateful. It’s a huge relief. “
Take away meals: The Regans said they had initially found no satisfaction in calling the hospital or the insurer to resolve their dispute – but it was the right thing to do.
“He’s certainly not the only one,” said Sabrina Corlette, a research professor at the Center for Health Insurance Reforms at Georgetown University. “The bottom line here is that the provider and the insurance company are still on a learning curve about this virus and how to charge and pay for it. “
Corlette said that Timothy should not have reconsidered his decision to use the Denver Health emergency when he was led there by a nurse. It was also the right call.
Insurers’ decision to forgo costs associated with COVID-19 tests and associated treatments is critical to stemming the epidemic – but it only works if patients can trust that they won’t be stuck on a big bill, a she said. “It is an essential part of the public health strategy to defeat this disease,” said Corlette.
To help with billing, she said, patients can ask their provider to write down their medical records when they seek care for a possible COVID-19 case. But it’s not the patients’ responsibility to make sure providers use the correct billing code, she said. Patients should know that they have the right to appeal their costs to their insurer. They can also ask for help from their employer’s benefits department and the state insurance department.
The Bill of the Month is a participatory survey by Kaiser Health News and NPR who dissects and explains medical bills. Do you have an interesting medical bill to share with us? Tell us about it!