The Most Unwelcome Surprises

COVID-19’s Surprise Medical Billing Problem

By Zach Brown

More than 500,000 Americans have already been hospitalized with the coronavirus so far and unfortunately this number will keep expanding while COVID-19 infection rates continue to rise across the country. Huge gaps in the U.S. health care system mean far too many Americans lack insurance or are underinsured. This has compounded the suffering for COVID-19 patients since so many people have been faced with high costs of care at a time when Americans are already financially vulnerable due to the economic downturn resulting from the Trump Administration’s failed response to the pandemic. Even COVID-19 patients who are insured are not safe from the high cost of care. This is due to the rising numbers of “surprise medical bills” – costly medical expenses charged to patients when out-of-network services are provided in a setting the patient thought was considered “in-network,” often without their knowledge, saddling with the majority of these patients staggering fees.

A recent New York Times (NYT) piece, “A $52,112 Air Ambulance Ride: Coronavirus Patients Battle Surprise Bills” provides much needed perspective on the issue by chronicling anecdotes of people hit with surprise billing during the COVID-19 crisis. The NYT did that by collecting reader submissions, now from over 350 different people, highlighting that surprise medical bills have been a widespread occurrence across the provision of COVID-19 care. In addition to the article detailing a particularly egregious $52,112 bill sent to a 60-year-old woman with her life hanging in the balance, it provides multiple other examples of patients being unknowingly stuck with thousands of dollars in bills for care they thought would be covered by their insurance.

Tragic stories like these are becoming more common, and they are not exclusive to times when people thought all the care they were receiving would be covered since they were being treated in an “in-network” facility. Ambulances and emergency services, largely overlooked expenses in the national COVID-19 health care conversation, often mean devastating financial bills for Americans nationwide. A recent JAMA Internal Medicine study shows that 86% of ambulance rides to emergency rooms lead to out-of-network bills.  With the present financial pressures of COVID-19 currently weighing on so many Americans, these costly surprise bills are even more unacceptable than they were in pre-pandemic times.

Americans have even been stuck with surprise medical bills for getting tested for COVID-19. While the economic stimulus bill, the CARES Act, passed earlier this year, attempted to shore up public safety by maximizing the number of people getting tested by guaranteeing that coronavirus tests would be given to Americans at no cost, recent reports show that these new protections aren’t always being recognized by private insurance companies that are more focused on profit than patient health. By taking advantage of loopholes in our overly complex private health care system, insurance companies force everyday Americans to foot the bill for a medical service that would have been provided freely in any other wealthy country. The health data firm Castlight has already concluded that about 2.4 percent of coronavirus tests have left patients responsible for at least part of the bill for a testing service that America’s leaders determined patients shouldn’t be charged for. This statistic is especially troubling since drastically more testing will be required to control the worsening pandemic throughout the fall and into the winter—potentially hitting millions of additional Americans with unexpected bills for COVID tests.

It’s not just unexpected charges for COVID testing and ambulance rides that are causing financial pain—these surprise bills can be triggered by a wide variety of different scenarios, including but not limited to: when patients unknowingly receive emergency care from an out-of-network facility, receive care at an in-network facility but from an out-of-network provider, when a person is evaluated for COVID-19 but for some reason does not receive a COVID-19 test, when patients have short-term health insurance (“junk plans”) that do not guarantee the Affordable Care Act’s protections, when employers require COVID-19 testing as a part of a workplace screening, and, of course, when patients’ don’t have health insurance at all.

But the truly saddest part of all is that this unconscionable phenomenon could have been prevented if we weren’t faced with this in-network/out-of-network dilemma. While COVID-19 has presented several unique stresses on our health care system, surprise billing has highlighted, and in some cases exacerbated, the long-standing failures of our current for-profit health care system. Though banning surprise medical bills must be included in any ensuing COVID-19 relief package, this would just be addressing one small piece of our broken health care system, which has been causing unnecessary sickness, death, and bankruptcy for decades.

By passing Medicare for All, we could finally eradicate surprise billing once and for all. Instead of some insurance companies covering only certain procedures and services in a limited number of facilities, Medicare for All would allow doctors and hospitals to be paid directly by the government, guaranteeing that everyone in the U.S. can finally get the care they need when they need it.

It’s clear that COVID-19 has forced all of us to adjust to a new reality. Why should we also be forced to keep a broken health care system? Join Public Citizen in the fight for a more equitable health care system.