For many Kansans, landing in the hospital with COVID-19 could easily cost thousands more dollars now than earlier in the pandemic.
It’s the latest, financial reason that experts encourage people to get vaccinated.
The vast majority of people hospitalized with the coronavirus today never got their shots against the disease. Getting the coronavirus vaccine gives you excellent odds of staying out of the hospital.
Early in the pandemic, most major insurance companies and many employers promised to waive cost-sharing (coinsurance, copays, deductibles) if you caught COVID-19 and needed medical care.
“Insurers were voluntarily waiving deductibles and copays,” said Krutika Amin, a researcher at the Kaiser Family Foundation. “The environment has shifted with the safe and highly effective vaccines that are now widely available.”
In recent months, most health plans nationwide appear to have dropped those promises. Others plan to make the same move in coming weeks or months. That includes Kansas’ two largest insurers, Blue Cross Blue Shield of Kansas and Blue KC.
If you come down with a nasty case of COVID-19 and end up in the hospital, the key money things you need to worry about are your health plan’s network, its cost-sharing rules and the risk of surprise bills.
Here’s the lowdown for Kansans who have health insurance, including cost-sharing rules for major insurers and health plans in Kansas.
(Side note: If you don’t have insurance, you’re in an even more precarious situation. A typical COVID-19 hospital stay can easily add up to $20,000 at prices negotiated by insurers. The uninsured risk getting charged even higher amounts.)
You may not be able to stay in-network.
Many Kansas hospitals are so busy right now that they can’t take on more patients. Some have even had to divert ambulances to other hospitals. And some are sending critically ill patients in air ambulances to beds in other states hours away from home.
All of this means that you can’t count on getting admitted to a hospital within your insurance network if you wind up needing intensive care.
Those air ambulances — with their eye-popping bills — could also easily fall outside your network. Last year we wrote about one COVID-19 patient’s $80,000 bill for an air ambulance from southeast Kansas to Kansas City.
So what happens if you end up in an out-of-network ICU? Experts say you may end up paying out-of-network rates for that care, or need to spend long hours filing paperwork and talking to your insurance carrier, making your case that the bills should count as in-network because you had no control over which hospital had a bed available.
“The patient — or, in many cases, it’s going to be a family member — needs to talk to the insurance company right away,” said Jack Hoadley, a health policy researcher and professor emeritus at Georgetown University. “Ask the insurance company: ‘Will you treat me as in-network?’”
If all else fails and your health plan falls under state regulations, you can also contact the Kansas Insurance Department through its online complaint form to see if the agency can help. But many employer plans do not fall under state rules.
Cost-sharing waivers for COVID-19 hospital bills are disappearing.
The Kaiser Family Foundation found most of the biggest insurers in each state have dropped their cost-sharing waivers.
Below are several major insurers active in Kansas, but keep in mind that the rules may be different if you get your coverage through your employer.
For Aetna, United HealthCare and Cigna, regular cost-sharing applies to COVID-19 hospital bills. Oscar returns to regular cost-sharing on Aug. 31. Medica does at the end of September.
Blue Cross Blue Shield of Kansas will keep waiving cost-sharing for COVID-19 treatment until the end of the public health emergency or the end of this year — whichever comes first. And Blue Cross Blue Shield of Kansas City will waive cost-sharing for inpatient COVID-19 care at least until the end of the year.
If you have KanCare (Medicaid), your COVID-19 treatment will not involve cost-sharing. If you have Medicare, the amount you pay out of pocket will depend on the details of your coverage.
Watch out for surprise billing, even though Congress tried to rein it in.
Normally, you can get billed directly by an out-of-network hospital or even by out-of-network doctors at an in-network hospital. These “surprise bills” happen when the hospital or doctor feels your insurance didn’t pay enough, and so they demand you pay the balance.
Congress tied strings to its COVID-19 stimulus funds last year to stop that, but those rules don’t apply to all health care providers. Moreover, Hoadley says it’s unclear how well the law is being enforced or followed.
Next year, things will get better. Congress banned most kinds of surprise billing — ground ambulances not included — for health plans that start on Jan. 1, 2022 or later.
COVID-19 vaccines are free. Many coronavirus tests are, too.
The shots that can help you avoid those hospital bills in the first place are free, whether you have insurance or not.
You can also get a free COVID-19 test by picking a site through Kansas’ online list of participating locations. No insurance or ID needed.
If you opt instead to go somewhere else and use your insurance, cost-sharing rules will depend on whether the test was medically necessary.
Celia Llopis-Jepsen reports on consumer health for the Kansas News Service. You can follow her on Twitter @celia_LJ or email her at celia (at) kcur (dot) org.
The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.
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