UnitedHealthcare officials later reviewed his case and waived his cost
sharing for the visit.
April.(Ethan Welty / Ethan Welty)
By Kaiser Health News 6:00 AM
on May 31, 2020
From late March into
April, Timothy Regan had severe coughing fits several times a day that often
left him out of breath. He had a periodic low-grade fever, too.
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 immediately go to the hospital system’s urgent care facility.
When he arrived at
Denver Health — where the emergency room and urgent care facility sit side by
side at its main location downtown — a nurse directed him to the ER after he
noted chest pain as one of his symptoms.
Regan was seen
quickly and given a chest X-ray and electrocardiogram, known as an EKG, to
check his lungs and heart. Both were normal. A doctor prescribed an inhaler to
help his breathing and told him he might have bronchitis. The doctor advised
that he had to presume he had COVID-19 and must quarantine 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 for his
inhaler prescription to be filled.
Regan wasn’t
concerned just 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 similar to those of COVID-19 in April. “Nothing terrible, but enough
to make me worry,” he said.
Regan, an estimator
for a construction firm, worked throughout his sickness — including while
quarantined at home. (Construction in Colorado and many states has been
considered an essential business and has continued to operate.) Regan said he
was worried about taking a day off and losing his job.
“I was thinking I had
to make all the money I could in case we all had to be hospitalized,” he said.
“All I could do was keep working in hopes that everything would be OK.”
Within a couple of
weeks, the whole family, indeed, was OK. “We got lucky,” Elissa said.
Then the bill came.
_______________________________________
Case
summary
The patient: Timothy Regan,
40, an estimator for a construction company. The family has health insurance
through Elissa’s job at a nonprofit in Denver.
Total bill: Denver Health
billed Regan $3,278 for the ER visit. His insurer paid $1,042, leaving Regan
with $2,236 to pay based on his $3,500 in-network deductible. The biggest part
of the bill was the $2,921 general ER fee.
Service provider: Denver Health,
a large public health system.
Medical service: Regan was
evaluated in the emergency room for symptoms similar to those of COVID-19,
including a severe cough, fever and chest pain. He was given several tests to
check his heart and lungs, prescribed an inhaler and sent home.
What
gives
When patients use
hospital emergency rooms — even for short visits with few tests — it’s not
unusual for them to get billed thousands of dollars no matter how minor the
treatment received. Hospitals say the high fees come from having to staff the
ER with specialists 24 hours a day and keep lifesaving equipment up to date.
Denver Health coded
Timothy’s ER visit as a Level 4 — the second-highest and 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
medication that provides quick relief for breathing problems.
The Regans knew they
had a high deductible, and they try to avoid unnecessarily using the ER. But,
with physician offices not seeing patients with COVID-type symptoms in April,
Timothy said he had little choice when Denver Health directed him first to the
urgent care, then to its ER. “I felt bad, but I had been dealing with it for a
while,” he said.
Elissa said they were
trying hard to do everything by the book, including using a health provider in
their plan’s network.
“We did not
anticipate being hit with such a huge bill for the visit,” Elissa said. “We had
intentionally called the nurse’s line trying to be responsible, but that did
not work.”
In an effort to
remove barriers from people getting tested and evaluated for COVID-19,
UnitedHealthcare is one of many insurers that announced it will waive cost sharing for COVID-19 testing-related visits
and treatment. But it is not clear how many people who had COVID-19 symptoms
but did not get tested when tests were in short supply have been billed as the
Regans were.
Resolution
A Denver Health
spokesperson said Regan was not tested for COVID because he was not admitted
and did not have risk factors such as diabetes, heart disease or asthma. He was
not billed as a COVID patient because he was not tested for the virus. The
medical center has since expanded its testing capacity, the spokesperson said.
UnitedHealthcare
officials reviewed Regan’s case at the request of KHN. Based on Regan’s
symptoms and the tests performed, Denver Health should have billed them using a
COVID billing code, an insurer spokesperson said. “We reprocessed Mr. Regan’s
original claims after reviewing the services that he received,” a United
Healthcare spokesperson said. “All cost share for that visit has been waived.”
The Regans said they
were thrilled with UHC’s decision.
“That is wonderful
news,” Elissa Regan said upon hearing from a KHN reporter that UHC would waive
their costs. “We are very thankful. It is a huge relief.”
The
takeaway
The Regans said they
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 definitely not
alone,” said Sabrina Corlette, a research professor at Georgetown University’s
Center on Health Insurance Reforms. “The takeaway here is both the provider as
well as insurance company are still on a learning curve with respect to this
virus and how to bill and pay for it.”
Corlette said Timothy
should not have second-guessed his decision to use the Denver Health ER when
directed there by a nurse. That, too, was the right call.
Insurers’ moves to
waive costs associated with COVID-19 testing and related treatment are vital to
stemming the outbreak — but it works only if patients can trust they won’t get
stuck with a large bill, she said. “It’s a critical piece of the public health
strategy to beat this disease,” Corlette said.
To help with billing,
she said, patients could ask their provider to note on their medical chart when
they are seeking care for possible COVID-19. But it’s not the patient’s
responsibility to make sure providers use the right billing code, she said.
Patients need to know they have the right to appeal costs to their insurer.
They can also seek assistance from their employer’s benefits department and
state insurance department.
Phil Galewitz is a
senior correspondent at Kaiser Health News who covers Medicaid,
Medicare, long-term care, hospitals and various state health issues. This Bill
of the Month article is a crowdsourced investigation by Kaiser Health News and NPR that
dissects and explains medical bills.
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