Diagnosing COVID-19 could be more expensive in 2021, study finds

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A pedestrian walks on Third Avenue wearing a face mask in New York in April. File photo by John Angelillo/UPI | License picture

COVID-19 could be a much more costly experience for people who get sick this year, thanks to the return of franchises and copays, new research suggests.

Most people who fell seriously ill with COVID-19 last year did not face crippling medical bills because almost all insurance companies agreed to waive cost-sharing for care against coronavirus at the height of the pandemic, explained Dr Kao-Ping Chua, a health specialist. policy researcher and pediatrician at the University of Michigan.

But some people got a big bill because their insurer refused to waive cost sharing, and their debts give a good idea of ​​what many hospitalized COVID-19 patients will have to pay this year, Chua said.

“We’ve had some very large insurers drop their cost-sharing waivers this year,” Chua said. “Insurers appear to be acting as if the pandemic is over, and we believe it is premature for them to act in this manner.”

Chua noted that since last week, some 20,000 Americans have been hospitalized with COVID-19 even though there has been a continued decline in cases.

For this study, Chua and his colleagues looked at claims data from several insurers across the United States, looking specifically for people who received a full bill for their COVID-19 hospitalization.

They identified more than 4,000 hospitalizations between March and September 2020 where it does not appear that the insurer waived cost sharing. These patients had to pay a share of all their care, from the hospital room to the doctors who saw them and the drugs they received.

People who did not receive cost-sharing exemptions ended up paying about $3,800, on average, out of pocket if they had private insurance and an average of $1,500 if they were covered by a plan. Medicare Advantage, according to the data.

“Now that insurers are dropping their cost-sharing waivers, that’s pretty much what the bills could be for patients covered by plans that chose to do so,” Chua said.

By comparison, respiratory infections in the pre-COVID-19 period from 2016 to 2019 resulted in average outlays for privately insured of $1,600 to $2,000, the researchers said in briefing notes.

The results have been published on the preprint server medRxiv and have not yet been peer reviewed.

The cost of treating COVID-19 “could be higher than the amounts you see in this study, in fact,” said Cheryl Fish-Parcham, director of access initiatives at Families USA, a national, nonpartisan health organization. advocacy for mainstream health care.

“Apart from the hospital costs themselves, people may face costs when they return home if they have long-term effects from COVID-19,” Fish-Parcham said.

Chua’s team also found that even those who got some sort of cost-sharing waiver still ended up paying for some of their COVID-19 hospital care.

About seven in 10 COVID-19 hospitalizations resulted in some sort of bill for privately insured patients, and about half of hospitalizations for those covered by Medicare Advantage.

Even though hospital charges were waived, people still received bills from the doctors who provided their hospital care and from the ambulance services that took them to the hospital, Chua said.

“Even though insurers’ cost-sharing waivers covered most of the bill, they did not cover all COVID-19 hospital care,” Chua said.

These people faced average bills of nearly $800 with private insurance and nearly $300 with Medicare Advantage.

While the threat of a big COVID-19 hospital bill could make some people reluctant to get vaccinated, Chua said he “prefers that it’s not how people are convinced to get vaccinated.”

That’s because he fears the risk of a big hospital bill could prevent people from getting life-saving care.

“I don’t want the possibility of high cost sharing to deter people from getting the care they need,” Chua said.

If insurers continue to waive COVID-19 cost-sharing waivers, the U.S. federal government must step in, Chua concluded.

“Consideration should be given to a federal mandate that requires insurers to cover all costs of COVID-19 hospitalizations for the duration of the pandemic,” Chua said.

Fish-Parcham hopes the federal government will also step in to limit out-of-pocket spending for all health care, COVID-19 or not.

In the meantime, many states offer consumer assistance programs that help people resolve billing issues between patient and insurer, Fish-Parcham noted.

“We encourage consumers to use these programs if they exist in their states,” Fish-Parcham said.

Insurance industry group America’s Health Insurance Plans did not respond to a request for comment.

More information

The United States Centers for Disease Control and Prevention know more about COVID-19.

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National Institutes of Health official Dr. Anthony Fauci (C) speaks about the coronavirus during a press briefing at the White House in Washington, D.C. Health and Human Services Secretary Alexander Azar (L) announced that the United States was declaring the virus an emergency public health concern and issued a 14-day federal quarantine order for 195 Americans. Photo by Leigh Vogel/UPI | License picture
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