Q & A: September 2020

Q & A: September 2020

Why Did Dad Get a Bill for $2,944 After Hospitalization for COVID-19?

Q:  Why did Dad get a bill for $2,944 after his recent hospitalization due to COVID-19?  I thought emergency legislation required coronavirus care to be covered by Medicare.  Dad is enrolled in a large Medicare Advantage plan.

A:  Emergency legislation passed earlier this year required health insurers, including those participating in Medicare, to cover both the coronavirus test, and associated care for COVID-19 without cost sharing.  But it’s becoming clear that patients may still be vulnerable to “surprise” medical bills for costs they thought would be covered.  We hope that your dad is not another such case.

Medicare Advantage plans have the flexibility to waive co-pays and deductible costs for patients in cases of a disaster or emergency.  Most Medicare Advantage insurers announced they are doing so for treatment of COVID-19.  To learn the details of what your dad’s health plan is doing to respond to COVID-19, you can find a list Medicare Advantage insurers and how they are responding on the website of the American Health Insurance Plans (AHIP).

Medicare Advantage enrollees have certain protections under a declared emergency.  During the period of the declared emergency, Medicare Advantage plans are required to cover services at out-of-network facilities, or out-of-network providers that participate in Medicare, and charge no more than they would pay if they had received care at an in-network facility or provider.  That said, it’s much less clear how billing from out-of-network providers will be handled as declared state and national emergencies are lifted.  As COVID-19 cases have increased, some states have found the need to bring in emergency nursing and professional staff when hospitals have reached capacity, so the chance is higher that an out-of-network provider was involved in your father’s care.

There are other reasons why your dad might have received that bill.  While Medicare Advantage enrollees would not have to pay cost sharing due to COVID-19, they might if hospitalized due to other reasons, such as heart attack or kidney failure.  You may need to call your dad’s health plan and find out how the reason for hospitalization is described on the bill.

The amount of the bill that your dad received, however, is not necessarily unexpected.  Medicare Advantage plans charge daily co-payments for hospital stays.  A one week stay in the hospital, with respiratory support, could easily cost in excess of $2,944.

We strongly recommend that you call your dad’s health plan and ask for a detailed statement including dates of stays and services billed.  Keep careful notes of your call.  If you are still unsatisfied, you can get free one-on-one counseling through your state health insurance assistance programs (SHIP) that may be able to help you determine what costs should have been covered and whether you should appeal the charges.  Find a program in your area here.