• Posted March 23, 2022

COVID Hospital Stays Leave Some Survivors With Big Medical Bills

Severe COVID can inflict heavy physical damage on patients, but many recovering from their infection also take a financial hit, a new study finds.

Up to 10% of patients hospitalized with COVID-19 are billed $2,000 or more six months after leaving the hospital, even when insurance providers waive their charges, researchers report.

"Bills for post-discharge care can be large for some patients hospitalized for COVID-19. The combination of these bills and the bill for the hospitalization could lead to financial toxicity for tens of thousands of Americans," said lead researcher Dr. Kao-Ping Chua, an assistant professor of pediatrics at the University of Michigan Medical School.

In an earlier study, Chua's team found that having a severe case of COVID can incur hospital charges of $1,600 to $4,000 for many patients.

For patients hospitalized for COVID-19 in 2020, many insurance companies waived hospital fees that patients had to pay, but those waivers have expired even though the pandemic continues.

For the study, Chua and his colleagues analyzed out-of-pocket costs to nearly 8,000 hospitalized patients from March through December 2020. They looked at costs incurred within the six months after leaving the hospital. Patients with private insurance were billed on average just under $290, and those with Medicare Advantage about $270, so most patients had modest costs.

Yet for nearly 11% of privately insured patients and 9% of people covered by Medicare Advantage, these bills totaled $2,000 or more.

These out-of-pocket costs for after-hospital care were driven by additional hospitalizations, procedures, prescription drugs and nursing home care, the researchers found.

The researchers also looked at bills received by pneumonia patients after leaving the hospital. They found that these patients had slightly higher out-of-pocket costs, possibly because most insurers waived out-of-pocket costs for COVID-19 readmissions in 2020.

For people hospitalized for COVID in 2021 and 2022, the researchers noted these out-of-pocket costs would likely be higher, because temporary waivers issued by insurance companies have expired.

"Insurers should do more to protect COVID-19 survivors from financial toxicity," Chua said. "A good first step would be to reinstitute their cost-sharing waivers for COVID-19 hospitalizations."

Frederick Isasi is the executive director of Families USA, a nonprofit advocacy organization. "This study shows how important and hard it is to protect people from expensive, out-of-pocket medical costs, even during a pandemic," he said. "No one should have to choose between going to the doctor and paying their rent."

Even though the families in this study had health insurance and federal financial protections for COVID-related care, some were still billed thousands of dollars in cost-sharing for COVID hospitalizations. More than 10% of privately insured patients and almost 20% of Medicare Advantage patients had out-of-pocket spending exceeding $2,000, Isasi noted.

"That is more than some people earn in a month or have on hand for an emergency. It's wrong that anyone has to risk financial ruin when they seek health care services, least of all during a pandemic," Isasi said.

Of course, not getting COVID-19 in the first place is the best option. Families USA strongly believes that everyone should have access to COVID vaccinations and that immunization is an essential component of slowing its spread.

The report was published March 16 in the American Journal of Managed Care.

Dr. David Katz, president of True Health Initiative, a nonprofit organization that promotes healthy living as the best way to prevent disease, said that high out-of-pocket costs can negatively affect health.

"High out-of-pocket expenses post-discharge might be considered the addition of literal insult to injury," Katz said. "Of more concern than the affront, however, is the potential sabotage of recovery."

If costs for essential medications are out of reach, those medicines may never be used and recovery may falter. "This area is just another of the many gaps in a system of care coverage cobbled together without consideration of how incentives and imperatives should align," Katz said.

"In all probability, high costs fall on those least able to pay and compromise their return to health. That, in turn, compounds financial problems by generating more costs associated with complications and by impeding a return to work," Katz said.

More information

For more on COVID-19, see the U.S. Centers for Disease Control and Prevention.

SOURCES: Kao-Ping Chua, MD, PhD, assistant professor, pediatrics, University of Michigan Medical School, Ann Arbor; Frederick Isasi, JD, MPH, executive director, Families USA; David Katz, MD, MPH, specialist, preventive and lifestyle medicine, and president, True Health Initiative, Tulsa, Okla; American Journal of Managed Care, March 16, 2022