COVID-19 medical bills: What patients can expect to pay

The federal government has told hospitals it will pick up the cost for uninsured patients treated for COVID-19, although no formal proposal or process has been put forward. Hospitals offer financial assistance, or charity care, for people with incomes up to 300% of the federal poverty level which is $38,280 for a household of one and increasing with household size up to $132,360 for a household of eight, and $4,480 for each person over eight, although many hospitals offer more generous benefits. For those with higher incomes but without insurance, Northwell Health will charge commercial insurer rates and offer no-interest repayment plans, now deferred for at least 90 days. Until May 15, New Yorkers can apply within 60 days of losing their health insurance to the New York State of Health Marketplace for individual coverage.

That's up to their insurer. Some insurers, including Empire Blue Cross Blue Shield, UnitedHealthcare, Cigna, Aetna and Humana have waived consumer cost-sharing from April 1 to May 31 for fully insured patients. Plans regulated under the federal Employee Retirement Security Act, or ERISA, which are self-funded by employers but administered by these insurers, can opt to offer such waivers but are not required to. Northwell Health is trying to work with insurers to have them waive costs for patients hospitalized in March before the waivers took effect, said Richard Miller, its executive vice president and chief business strategy officer.

COVID-19 testing is available without copays or deductibles in almost all plans, although other procedures performed to rule out COVID-19 may not be, including CT scans, X-rays and tests for other infections.

According to Janine Logan, a representative for the Nassau-Suffolk Hospital Council, as hospitals are following the rules set out by state and federal governments waiving cost-sharing for COVID-19 testing and/or treatment. “Legally and contractually, they cannot waive deductibles and co-payments on their own volition,” Logan said.

Logan said New York State’s Surprise Billing law protects many patients in emergency situations from physician and hospital charges in excess of in-network copays, deductibles and coinsurance. It covers state-regulated plans and Medicaid beneficiaries, but does not cover self-insured plans or ERISA plans. However, Medicare providers, which include most hospitals, had to agree not to charge patients out-of-network rates as a condition of receiving federal coronavirus relief aid.

Given the complexity of each case, there is no typical bill, Logan said. But, she said, “For those on ventilators and/or on dialysis for a protracted length of time, the costs can run into the hundreds of thousands” of dollars. That is the cost to insurers, although patients with high deductibles, copays or coinsurance could face substantial costs.

According to Logan, the billing cycles usually takes two to four weeks after a patient is discharged. Northwell Health, however, is holding on to thousands of patient bills and will not send them out until insurers have had enough time to revamp their claims processing system to reflect waivers of consumer cost sharing, Miller said. He said no copays were currently being collected from COVID-19 patients while insurers adjust their billing.

The 20% cost-sharing for Medicare beneficiaries is limited to physician and outpatient services for those that have traditional Medicare Part B coverage with no supplemental insurance, Logan said. Hospital bills are covered under Medicare Part A, which has a deductible and coinsurance after 61 days. Patients with supplemental coverage should check with their insurer about waivers and cost shares.