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Hospital Bills Are Covered For Uninsured Covid-19 Patients, But No One Tells Them That

Hospital Bills Are Covered For Uninsured Covid-19 Patients, But No One Tells Them That

uninsured
Dr. Ala Stanford administers a covid-19 swab test on Wade Jeffries in the parking lot of Pinn Memorial Baptist Church in Philadelphia, April 22, 2020. Stanford and other doctors formed the Black Doctors COVID-19 Consortium to offer testing and help address health disparities in the African American community. (AP Photo/Matt Rourke)

Darius Settles knew he was in bad shape with the coronavirus. He’d already been hospitalized twice, but without health insurance, he worried about how he would pay the bills and he didn’t attempt to make a third trip to the hospital.

When he died on July Fourth at age 30, Darius, a Black man, was one of the youngest covid fatalities in Nashville, Tenn. at that point. The mayor noted his passing so young without any underlying conditions.

Darius left behind his wife, Angela Settles, and a 6-year-old son.

He died not knowing that uninsured patients with covid-19 have their bills covered as part of the pandemic relief legislation set up by the CARES Act.

Black Americans have been disproportionately affected by coronavirus. It is now the third leading cause of death in the U.S. after heart disease and cancer, according to a Brookings Institution study.

Angela spoke about the needless stress suffered by Darius and his family in his last days and information about medical insurance withheld from them that might have saved her husband’s life, according to Nashville Public Radio.

Darius was between full-time jobs when he got sick. He was playing the organ at a church and launching a career as a suit designer, so he had no health insurance. Angela works for Tennessee State University.

When Darius experienced breathing difficulties, he returned to TriStar Southern Hills Medical Center, owned by the for-profit hospital chain HCA, NPR reported. His blood oxygen levels had dropped to 88 percent and an X-ray of his lungs “appears worse,” the physician wrote in the record.

But Darius told his wife, “I might as well go home.”

The federal government would have paid the bill but no one said that when it might have made a difference to Darius.

TriStar doesn’t tell its patients upfront that it participates in a program through the Centers for Medicare and Medicaid Services in which uninsured patients with covid-19 have their bills covered. 

That’s because it doesn’t have to, according to Jennifer Tolbert, who studies uninsured patients with the Kaiser Family Foundation. Neither do other hospitals or national health systems contacted by WPLN News. It’s one of the program’s shortcomings, Tolbert said.

People without insurance often avoid care because of the bill or the threat of the bill, even though they might qualify for programs if they ask enough questions, her research finds.

Even doctors don’t always know that the covid-19 uninsured program exists or how it works. The time to address the issue is when the patient shows up at the hospital, Tolbert said.

However, hospital staff are afraid to bring up cost in any way for fear of violating federal laws. Emergency rooms are required to stabilize everyone, regardless of ability to pay, under a federal law known as the Emergency Medical Treatment and Labor Act, or EMTALA. Asking questions about insurance coverage is often referred to as a “wallet biopsy,” and can result in fines for hospitals or even being temporarily banned from receiving Medicare payments, NPR reported.

Angela Settles wonders if she and the hospital could have done more for Darius.

After failing to disclose its policy for uninsured covid-19 patients, the hospital sent her a bill for part of her husband’s care. Asked why, a TriStar spokesperson said it was sent in error and does not have to be paid.

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The CARES Act, signed on March 27, 2020, allocated $175 billion in relief funds to help hospitals and health care providers respond to covid-19.

There are other limitations that raise concerns in the program for uninsured covid-19 patients, Karyn Schwartz and Tolbert wrote in an Oct. 9 Kaiser Family Foundation report.

  • Reimbursement is contingent upon a primary diagnosis of covid-19. This can cause issues with billing and coding protocols.
  • Providers are not required to participate in the program. Patients cannot easily find out which providers participate.
  • The program does not guarantee reimbursement for providers—instead reimbursement is contingent on available funding. The Department of Health & Human Services has announced provider grant allocations that total $143.9 billion, including $20 billion in grants announced on Oct. 1. There is $31.1 billion remaining in the fund.

Almost all hospitals have taken a financial hit since the coronavirus outbreak, Time reported. Operating margins for U.S. hospitals were down 89 percent January through August 2020, excluding federal relief funds, according to a September report from hospital insights firm Kaufman Hall.