John Druschitz spent five days in a Texas hospital last April with fever and shortness of breath as doctors puzzled over a diagnosis.
They initially suspected coronavirus.
But ensuing lab work was ambiguous: Multiple molecular tests for coronavirus came back negative, but an antibody test was positive.
Doctors found that Mr. Druschitz, 65, had an irregular heartbeat and blood clots in both his lungs. They sent him home on oxygen, and ultimately did not give a coronavirus diagnosis because of the negative tests. He didn’t think much about the decision until this fall, when he received a $22,367.81 bill that the hospital has since threatened to send to collections.
Working with a patient advocate, he discovered that his debt stemmed in no small part from his diagnosis. Not having a coronavirus diagnosis disqualified his hospital from tapping into a federal fund to cover his bills.
Mr. Druschitz ultimately fell short of qualifying for multiple federal health programs that would have paid for his care if the details had been slightly different.
On the day the hospital admitted him, he was 64 years old, 23 days away from qualifying for Medicare. He had mistakenly terminated his private health plan one month early.
If his hospital visit had happened 24 days later, Medicare would have covered the vast majority of the costs.
Because he was uninsured, the hospital sent a letter less than a week after discharge offering to “help apply for medical assistance through various government programs.” Mr. Druschitz had not yet received a bill at the time. When it did arrive, six months later, he was told that offer had expired.
Another source of federal funding would have become available if the hospital had determined he had coronavirus: the Covid-19 Uninsured Program.
Created last spring, the program pays the medical bills of coronavirus patients who lack health coverage.
It has faced some criticism from hospitals and patients for being too narrow, and for covering bills only where coronavirus is the primary diagnosis. A patient with a primary diagnosis of respiratory failure and a secondary diagnosis of coronavirus would not qualify, for example.
The Health Resources and Services Administration, which runs the federal fund, does not have plans to change that policy. So far, it has spent $2 billion to reimburse health care providers for the bills of uninsured coronavirus patients.
Source: Read Full Article