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The cost of COVID-19: Is your insurance company paying their share?

What you need to know to avoid big bills
Gena Ross.jpg
Posted at 9:15 PM, Aug 19, 2020
and last updated 2020-08-20 00:43:18-04

KANSAS CITY, Mo. — At the start of the pandemic, the group Kaiser Family Foundation did a study estimating what costs you might face if you were hospitalized with COVID-19.

Researchers analyzed data for hospital stays for other serious respiratory illnesses from 2018 and estimated the average cost to a patient with insurance would be $9,763, and that's without complications.

They estimated a case of COVID-19 with serious complications could cost a patient as much as $20,292, with insurance, accounting for high deductibles and co-pays.

Since that study was published, most insurance companies have stepped up to cover COVID-19 costs.

But, as one local woman found out, you still need to double-check your bills.

Back in March, Gena Ross, Ph.D., was busy balancing campaigning for the 6th Congressional District of Missouri with teaching at Kansas City, Kansas, Community College.

Then, she got sick and her world turned upside down.

"The fevers were out of this world. I was just sweating, just drenched, then cold — freezing. The coughs just got worse, and my breathing, it just labored, really labored breathing, to the point where I couldn't breathe," Ross recalled.

She ended up in the hospital where a test confirmed she had COVID-19, and she quickly realized the severity of her situation.

"They put me on oxygen and the first question they asked is, 'If you stop breathing, do you want us to resuscitate you?'" Ross said.

After several days in the hospital, Ross recovered, but she was readmitted a month later after developing a severe case of bronchitis.

She said it was a complication from coronavirus.

In all, she spent nine days at a Saint Luke's hospital. Not long after returning home, she said the bills started coming in.

"I opened a few that were over a thousand dollars. I just put them to the side and I called, and said, 'Can I get some financial assistance?'" Ross said.

However, 41 Action News learned those bills should have been covered. Investigator Caitlin Knute talked with the vice president of revenue cycle of operations with the University of Kansas Health System.

Although she had no connection to Ross' care and couldn't comment on that case, she did explain COVID-19 patients should be eligible for help.

"Insurance companies basically have told us across the nation they will cover COVID screening and COVID care, with no deductible and no copay," Colette Lasack said.

The coverage comes with the condition that COVID-19 has to be the primary diagnosis.

Still, that was the diagnosis on Ross' charts for both hospital stays.

While her insurance company, Aetna, said they couldn't comment specifically on her case, they did provide this statement:

"We are waiving member cost-sharing for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19. In certain cases, the claims that we receive from health care providers may come in with multiple diagnoses (like bronchitis, for example). As soon as we find out that the claims are related to COVID-19, we make sure that they are processed correctly, with no cost-sharing for the member."

Shortly after 41 Action News contacted Aetna, Ross said the company called and told her her claims had been reprocessed and her balance was now $0, which came as a huge relief.

"The bills are real! And some people can afford them, but some people cannot," Ross said.

Her case serves as a reminder for patients to contact their insurance company if something doesn't seem right. Also, health leaders say it's important to understand what a plan does and does not cover.

For example, there are some things you can do now to protect yourself from a big bill later.

First, know your plan. Do you have a high deductible? If so, you might want to consider making a change. And, if you've experienced any kind of major life event, such as being furloughed or laid off, you have the option to make those changes now.

Second, do you know which hospitals are in your plan? Knowing which providers are in-network now could save you a lot of money later if you end up in the hospital.

Third, if you do end up with a bill you can't afford to pay, reach out for help.

"Call, and let's walk through it and make sure your insurance company really did pay the way we thought and you thought they were going to pay. We're working hard on behalf of the patient to try to make sure those insurance companies do pay everything they say they're going to pay," Lasack said.

Whether it's Covid-related or something else, hospitals want to remind patients if they can't afford to pay their entire bill at once, contact them to see if they qualify for financial assistance, or to set up a payment plan.

For example, the University of Kansas Health System offers payment plans spanning as long as five years, if need be.

Tomorrow, 41 Action News I-Team Investigator Caitlin Knute will look at the cost of COVID-19 for those without insurance, and the trickle-down effect that's having on hospitals.