Ethan Welty for KHN
From late March to April, Timothy Regan had severe cough passes several times a day which often left him breathless. He also had a periodic low-grade fever.
Wondering if he had COVID-19, Regan called a nurse hotel run by Denver Health, a large public health system in his city. A nurse listened to him describe his symptoms and told him to go to the hospital’s emergency facility immediately.
When he arrived at Denver Health – where the emergency room and urgent care facility sit side by side at its main downtown location – a nurse addressed him to the ER after noticing chest pain as one of his symptoms.
Regan was seen quickly and received an X-ray and chest electrocardiogram, known as an ECG, to check the lungs and heart. Both were normal.
A doctor prescribed an inhaler to help with breathing and told him he may have bronchitis. The doctor announced that he had to assume he had COVID-19 and had to be quarantined at home for two weeks.
At that time, April 3, Denver Health reserved COVID-19 tests for sicker patients. Two hours after arriving at the hospital, Regan was home. His longest wait was for his inhaler prescription to be filled.
Regan wasn’t worried about just his own health. His wife, Elissa, who is expecting her second child in August, and their 1-year-old son, Finn, also felt sick from symptoms like COVID-19 in April. “Nothing horrible but enough to make me worry,” he said.
Regan, who is an estimator for a construction company, worked from home throughout his illness – including during quarantine. (Construction in Colorado and many states has been considered an important business and has continued to operate.) Regan said he was worried about taking a day off and losing his job.
“I thought I had to make all the money I could if we all needed to be hospitalized,” he said. “All I could do was continue to work in the hope that everything would go well.”
Within a couple of weeks the whole family was really OK. “We were lucky,” Elissa said.
Then came the bill.
The patient: Timothy Regan, 40, an estimator for a construction company. The family has health insurance through Elissa’s job at a nonprofit organization in Denver.
Total bill: Denver Health billed Regan $ 3,288 for the ER visit. His insurance company paid $ 1,042 and left him $ 2,236 to pay based on his deductible $ 3,500 on the network. Most of the bill was the general ER fee of $ 2,921.
Service provider: Denver Health, a large public health system
Healthcare: Regan was evaluated at the emergency department for COVID-19-like symptoms, including a severe cough, fever and chest pain. He received several tests to check the heart and lungs, prescribed an inhaler and sent home.
What gives: When patients use emergency clinics in hospitals – even for short visits with few tests – it is not uncommon for them to be billed thousands of dollars, regardless of how much treatment was received. Hospitals say the high fees come from having to staff the ER with specialists around the clock and keeping life-saving equipment up to date.
Denver Health coded Timothy’s ER visit as Level 4 – the second highest and second most expensive – on a 5-point scale. The other items on his behalf were $ 225 for the ECG, $ 126 for chest X-ray, and $ 6 for his albuterol inhaler, a drug that provides quick relief for breathing problems.
Regans knew they had a high deductible and were trying to avoid unnecessary use of ER. But with a doctor’s office that did not see patients with COVID-19 symptoms in April, Timothy said he had little choice when Denver Health first led him to its urgent care and then to its ER. “I felt bad, but I had been working on it for a while,” he said.
Elissa said they tried hard to do everything in the book, including using a healthcare provider in their plan network.
“We did not foresee being beaten with such a big bill for the visit,” Elissa said. “We had deliberately called the nurse’s line to try to be responsible, but it didn’t work.”
In an effort to remove barriers to people being tested and evaluated for COVID-19, UnitedHealthcare is one of many insurance companies that announced that it will waive the cost sharing for COVID-19 test-related visits and treatment. But it is not clear how many people who had COVID-19 symptoms but who could not be tested when tests were deficient have been billed as Regans was.
Resolution: A Denver Health spokesman said Regan was not tested for COVID-19 because he was not adopted and did not have risk factors such as diabetes, heart disease or asthma. He was not billed as a COVID-19 patient because he was not tested for the virus. The medical center has since expanded its testing capacity, the spokesman said.
UnitedHealthcare officials reviewed Regan’s case at the request of Kaiser Health News. Based on Regan’s symptoms and the tests performed, Denver Health should have billed them using a COVID-19 billing code, said an insurance spokesman. “We worked up Mr. Regan’s original claims after reviewing the services he received,” a UnitedHealthcare spokesman said. “All cost share for that visit has been lifted.”
Ethan Welty for KHN
Regans said they were pleased with UHC’s decision.
“It’s wonderful news,” Elissa said after hearing from a KHN reporter that UHC would waive its costs. “We’re very grateful. It’s a huge relief.”
Collection: Regans said they initially found no satisfaction in calling the hospital or the insurer to resolve their dispute – but that was the right thing to do.
“He’s definitely not alone,” says Sabrina Corlette, a research professor at Georgetown University’s Center for Health Insurance Reforms. “The takeaway here is both the provider and the insurance company are still on a learning curve regarding this virus and how to bill and pay for it.”
Corlette said Timothy should not have second-guessed his decision to use the Denver Health ER when being led there by a nurse. It was also the right call.
Insurance companies’ transition to waiving costs associated with COVID-19 testing and related treatment is crucial to preventing the outbreak – but it only works if patients can trust that they won’t get stuck on a big bill, she said. “It is a critical part of the public health strategy to beat this disease,” Corlette said.
To help with billing, she said, patients could ask their provider to note on their medical chart when seeking care for a possible case of COVID-19. But it is not the patient’s responsibility to ensure that suppliers use the correct billing code, she said. Patients must know that they have the right to appeal to their insurer. They can also seek help from their employer’s benefit department and state insurance department.
The month’s bill is a public inquiry into Kaiser Health News and NPR dissecting and explaining medical bills. Do you have an interesting medical bill that you want to share with us? Tell us about it!