Patients Hospitalized for COVID-19 Now Could Pay Thousands of Dollars

With insurance companies once again charging hospital-related fees to members, analysis of 2020 data shows what they may be owed.

Americans who become seriously ill from COVID-19 in 2021 may have to pay thousands of dollars in bills from their hospitals, doctors and ambulance companies, a new study suggests.

The new University of Michigan analysis, published in JAMA Network Open, has implications for both policymakers and people who have not yet been vaccinated, as well as those with underlying conditions that put them at risk for a serious breakthrough case of COVID-19.

Most health insurers voluntarily waived co-payments, deductibles and other cost-sharing for hospitalized COVID-19 patients in 2020, but many major insurers lifted those waivers in early 2021. Tens of thousands of Americans have become seriously ill and require hospital or emergency care in the wave of cases that has happened since early 2021.

Based on data from actual patients hospitalized for COVID-19 last year, the study suggests that the lack of waivers could lead to bills of about $3,800 for those with work-related or self-purchased private insurance, and $1,500 for people with Medicare Advantage plans.

“Many insurers argue that charging patients for COVID-19 hospitalizations is justified now that COVID-19 vaccines are widely available,” said lead author Kao-Ping Chua, MD, Ph.D. health policy and pediatrician in Michigan Medicine and the Susan B. Meister Child Health Evaluation Research Center. “However, some people hospitalized for COVID-19 are ineligible for vaccines, such as young children, while others are vaccinated patients who have had a severe breakthrough infection. Our study suggests that these patients could have significant bills.”

The new study analyzes more than 4,000 COVID-related hospitalizations of people with private insurance and Medicare Advantage insurance between March and September 2020. The data is from the IQVIA PharMetrics Plus for Academics Database, which includes claim data from multiple insurers in the US. .

The researchers found that the vast majority of patients did not have to pay for hospital services such as room-and-board changes, suggesting that their plans forgo cost-sharing for bills sent by hospitals. The out-of-pocket costs of the few patients who did have to pay for hospital services — a sign that there was no waiver — ran into the thousands of dollars.

That amount billed directly to patients is a small fraction of the average cost of care for a hospitalized COVID-19 patient. The study finds that each hospitalization of a person with private insurance cost an average of $42,200 in total, and that each hospitalization of a person with COVID-19 who had Medicare Advantage coverage averaged about $21,400.

Chua and colleagues originally published the findings as a preprint in June 2021. Since then, the Kaiser Family Foundation analyzed the status of waivers of the two largest insurers in each state and found that 72% had ended their waivers for COVID-19 hospitalizations by August. 2021.

Exemptions don’t always cover doctors’ bills

The study also suggests that insurers’ cost-sharing waivers for COVID-19 hospitalizations do not always cover all hospital-related care.

For example, patients in the study often received bills from the doctors who cared for patients in the hospital and from ambulance companies.

Overall, 71% of privately insured patients received a bill for a hospitalization-related service, with an average size of $788. Of those with Medicare Advantage coverage, 49% received a bill, with an average size of $277.

Chua notes that some insurers may have only waived cost-sharing for the hospital portion of the bill, but believes it is possible that some patients may have been incorrectly billed for physician and ambulance services because insurers misrepresented their waivers. implemented or health care providers have not coded all aspects of care related to COVID-19.

For people receiving a bill for COVID-19 hospitalization-related care, even though their insurer still has a waiver, Chua recommends contacting their insurer to find out if the bill was sent in error.

Policy implications

Chua believes charging patients for emergency hospitalizations is misleading, but is particularly concerned about the charging for hospitalizations due to COVID-19.

“One of my biggest concerns is that the threat of high costs could cause some patients with severe COVID-19 to delay hospital visits, increasing their risk of death,” he said.

To avoid this possibility, Chua said federal policymakers could require insurers to waive the cost of COVID-19 hospitalization-related care during the pandemic — just as they already do for COVID-19 testing and vaccination. He added, however, that policymakers are unlikely to do so, given the widespread anger against the unvaccinated.

Hospitals that have received special pandemic funding are already banned from charging patients beyond what their insurance covers. Hospitals are also reimbursed by the federal government when they care for uninsured COVID-19 patients.

Chua and colleagues also recently published a paper looking at the out-of-pocket costs for people over 65 in Medicare Advantage plans who were hospitalized for the flu, as a way to estimate possible out-of-pocket expenses for COVID-19 hospitalizations. That paper found that the average flu hospital bill was around $1,000.

Reference: “Assessment of Out-of-State Expenses for COVID-19 Hospitalizations in the US in 2020” by Kao-Ping Chua, MD, PhD, Rena M. Conti, PhD, and Nora V. Becker, MD, PhD, Oct. 18, 2021, JAMA network open.
DOI: 10.1001 / jamanetworkopen.2021.29894

In addition to Chua, the authors of the new study are Nora Becker, MD, Ph.D., a primary care physician and health economist at Michigan Medicine, and Rena Conti, Ph.D., an associate professor and health economist at Questrom Boston University School of Business.

Chua and Becker are members of the UM Institute for Care Policy and Innovation.