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Coronavirus and hospital bills: Medicare v. private health insurance

Written by Diane Archer

Joseph Goldstein reports for the New York Times on a patient with COVID-19 who was hospitalized for 19 days and received bills totaling more than $400,000. Congress provided hospitals with stimulus funds to help ensure that patients were not billed out of pocket for COVID-19 care. But, unless you have traditional Medicare, which requires hospitals and doctors to bill the government directly, you are at risk of receiving bills for services that you should not be paying.

Again, Congress passed legislation to keep hospitals from billing patients with private insurance for COVID-19 care. But, there appears nothing to stop hospitals from doing so other than good will. Mount Sinai hospital in New York billed one COVID-19 patient, who had insurance through CIGNA, $401,885.57.

Thinking the patient was uninsured because it did not have insurance information for her, it discounted her bill by $326,851.63, a “financial assistance benefit.” She was left with $75,000 in costs, even though the hospital had received $63.7 million from the government in COVID-19 stimulus money. Of note, hospitals can charge the federal government directly for uninsured patients.

Mount Sinai hospital admits that it erred when it billed the patient. It should have gotten her insurance information and billed CIGNA directly. Now, the patient has been left to try to work the bill out.

The bottom line is that the federal government does not have the ability to keep hospitals and doctors from billing people with private health insurance for services, even when they are not allowed to, as with most COVID-19 care.  [N.B. If the patient had traditional Medicare or, for that matter, if Medicare for All were enacted, the patient would never receive a hospital bill. The patient would not need to spend precious time getting the insurance company to pay and fending off collection notices.]

Although hospitals should not be billing insured patients directly for COVID-19 care, doctors can bill patients for their COVID-19 services. So, people can be charged significant out-of-pocket costs for their care. In the case involving Mount Sinai hospital, the patient believes she will be liable for as much as $10,000.

For the uninsured, the federal government has set up a billing system for hospitals to cover the cost of COVID care. It has effectively expanded Medicare to the uninsured, paying Medicare rates for their care.

Here’s more from Just Care:

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1 Comment

  • When it comes to healthcare America has surely lost its way. There aren’t many ways that America can stand next to the greater countries of the world any longer.

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