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‘An Arm And A Leg’: The $7,000 COVID Test And Other Lessons From SEASON-19

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Host Dan Weissmann spoke with three people who have very different reflections on what the COVID-19 pandemic is costing us.

  • A doctor and advocate in Brooklyn looked back on the wave of black and brown patients that filled her clinic in March.
  • A nurse practitioner in Texas shared how new tech is — and isn’t — helping the older patients she cares for.
  • One of the country’s top insurance nerds conceded that her initial policy ideas to keep people from getting stuck with expensive bills for COVID tests were wrong.

Here’s the season recap: A new abnormal. A shortage of hugs. And the $7,000 COVID test.

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“SEASON-19” of “An Arm and a Leg” is a co-production of Kaiser Health News and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

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KHN’s ‘What The Health?’: Still Seeking A Federal Coronavirus Strategy

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The Trump administration sent its COVID-19 testing strategy plan to Congress, formalizing its policy that most testing responsibilities should remain with individual states. Democrats in Congress complained that the U.S. needs a national strategy, but so far none has emerged.

Meanwhile, President Donald Trump, noticing that his popularity among seniors has been falling since the pandemic began, unveiled a plan to lower the cost of insulin for Medicare beneficiaries. However, while diabetes is a major problem for seniors in general and for Medicare’s budget, only a small minority takes insulin.

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Anna Edney of Bloomberg News and Erin Mershon of STAT News.

Among the takeaways from this week’s podcast:

  • The difficulties caused by the lack of a unified federal response to the pandemic can be seen by looking at other countries. Communities around the world face some of the same problems U.S. cities and states do, such as high numbers of cases in nursing homes and other congregate living facilities, and test shortages. But in other countries, the governments have taken the lead in working through the issues.
  • Recent episodes of crowds gathering as states reopen point to a breakdown in public health messaging. That may be partly attributable to the president’s ambivalence or a result of the recent cutback in press briefings and other direct communication from federal public health officials. But much of it could also be directly related to political divisiveness, which runs rampant.
  • With a Rose Garden ceremony, Trump announced the deal with drugmakers to limit Medicare beneficiaries’ out-of-pocket costs for insulin to $35. That is expected to save those patients on average more than $400 a year. But the announcement is a long way from the promises made by the administration to bring down drug prices for all Americans.
  • Republicans have touted short-term insurance plans as a cheaper alternative to health coverage offered under the Affordable Care Act’s marketplaces. But the COVID-19 pandemic has highlighted shortcomings of those plans, including that many don’t cover prescription medications or experimental treatments.
  • The pandemic has also spotlighted the administration’s intent to get more drug manufacturing — which has become concentrated in India and China — to return to the United States. The government recently announced it is starting a project with a Virginia company to add manufacturing capacity stateside.

Also this week, Rovner interviews KHN’s Phil Galewitz, who reported the latest KHN-NPR “Bill of the Month” installment about a patient with a suspected case of COVID-19 who did what he was told by his health plan and got billed, anyway. If you have an outrageous medical bill you would like to share with us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: ProPublica’s “The Feds Gave a Former White House Official $3 Million to Supply Masks to Navajo Hospitals. Some May Not Work,” by Yeganeh Torbati and Derek Willis

Also, The New York Times’ “My Mother Died of the Coronavirus. It’s Time She Be Counted,” by Elisabeth Rosenthal

Joanne Kenen: The New Yorker’s “The Town That Tested Itself,” by Nathan Heller

Anna Edney: The New York Times’ “Wealthiest Hospitals Got Billions in Bailout for Struggling Health Providers,” by Jesse Drucker, Jessica Silver-Greenberg and Sarah Kliff

Erin Mershon: The Washington Post’s “Coronavirus May Never Go Away, Even With a Vaccine,” by William Wan and Carolyn Y. Johnson

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Going The Distance By Bus Through A Pandemic

L.A. Metro bus driver Voris Lombard sits behind a partial Plexiglas shield and wears gloves and a mask while driving. After each shift, Lombard removes his uniform and shoes before entering his home, he says. “It’s almost like you’re going through a hazmat routine.”(Heidi de Marco/KHN)

LOS ANGELES — Mary Pierson boarded a nearly empty L.A. Metro bus at the corner of Atlantic Boulevard and Riggin Street in Monterey Park one recent afternoon.

Pierson, 69, uses a wheelchair and relies on public transportation to get around. She takes the bus a few times a week from Long Beach to various parts of Los Angeles to run errands and shop for groceries. Today, she took the No. 68 to the bank.

“I’m glad they’re still running,” said Pierson, who wears a mask, gloves and sunglasses on board and disinfects her wheelchair after every trip. “I live alone and need to get out of the house.”

She’s also often alone on the bus. Transit ridership has plummeted since mid-March, when states began imposing stay-at-home orders. The Los Angeles County Metropolitan Transportation Authority, known as L.A. Metro, said ridership has fallen 64% on buses — about 1.2 million people rode them each day before COVID-19 hit — and by 76% on rail.

Despite the risk of the coronavirus in public places, people are still boarding public buses and trains because they have no other options to get to work, go shopping and fill prescriptions.

“We’re still seeing over 400,000 people per day,” said Brian Haas, communications manager for L.A. Metro. “What that tells us is that we’re a lifeline for people.”

Perhaps the most vulnerable are the bus drivers and train operators. The Transport Workers Union of America has lost 96 members to COVID-19, the vast majority in New York City, the union says. None of the fatalities have been in California.

New methods of sanitation and decontamination, like ultraviolet lighting, should be used, said John Samuelsen, the union’s president. “Masks are the very minimum of what can be done to increase everybody’s safety,” he said. “We need to be thinking about what post-pandemic public transport will look like.”

To date, L.A. Metro has supplied front-line employees with more than 715,000 pairs of gloves, 385,000 masks and 40,000 bottles of personal hand sanitizer.

Until recently, face coverings had been optional on public transit in L.A. County.

But in early May, Los Angeles Mayor Eric Garcetti announced that all passengers on all Los Angeles Department of Transportation buses would be required to wear face coverings to reduce the spread of the virus. The department is a municipal agency that operates within the city and is separate from L.A. Metro. L.A. Metro started requiring passengers to wear face coverings May 11.

Because of the low ridership numbers, social distancing is usually not a problem on buses, said L.A. Metro bus driver Voris Lombard. “When people get on the bus, they have plenty of room to sit.”

Lombard, 59, checks out his bus at 10 a.m. before starting his route, which goes from downtown to Montebello. Lombard, a bus operator for 20 years, says he feels fortunate to still be working. “The people that require our services are essential workers,” he says. “That’s the satisfaction I get out of the job.”(Heidi de Marco/KHN)

Only two passengers ride Lombard’s bus on a recent morning.(Heidi de Marco/KHN)

Jose Salazar, 63, prepares to disembark. Salazar has depended on public transportation exclusively since he took his car to the shop a few weeks ago, and rides the bus several times a day to get around East L.A. and Monterey Park.(Heidi de Marco/KHN)

A sign near the front entrance of the bus asks passengers to board from the rear door. Rear-door boarding was implemented in March to help maintain proper social distancing and keep drivers safe. L.A. Metro asks its bus riders to “have” their fares, but is not requiring them to pay them, says Brian Haas, the system’s communications manager.(Heidi de Marco/KHN)

Rojelio Artalejo, 45, waits to board the No. 770 bus in Monterey Park. Artalejo is a janitor at a grocery store and depends on public transportation to get to work.(Heidi de Marco/KHN)

For extra protection, Mary Pierson wears batting gloves when she takes public transportation.(Heidi de Marco/KHN)

The front door of the bus is reserved for people with mobility devices, such as wheelchairs or walkers.(Heidi de Marco/KHN)

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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‘An Arm And A Leg’: Tips For Surviving COVID With Your Financial Health Intact

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In early April, Katelyn was in a financial bind. At home and sick with COVID-19, she hadn’t been paid in weeks. And her bills were due.

“My landlord is kinda beating down my door right now,” she said in a voicemail to the podcast hotline: (724) 276-6534; that’s 724 ARM N LEG.

Weeks later, Katelyn got back in touch: She had made it through with her financial health intact, thanks to a combination of playing hardball with one company and knowing how to play nice with others.

Katelyn works in collections for a financial institution, so she knew how to ask for help. Even so, she didn’t find the process easy. She came out of the ordeal with hard-won tips for all of us, and a heck of a story.

Here are two other resources from the episode: our favorite TikTok mom shares tips for dealing with medical bills and collection agencies, and Hello Landlord. It’s a free online tool that automatically generates letters you can send to your landlord, asserting your legal rights. (Right now, those rights may include some federal protections against evictions.)

“SEASON-19” of “An Arm and a Leg” is a co-production of Kaiser Health News and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

To hear all Kaiser Health News podcasts, click here.

And subscribe to “An Arm and a Leg” on iTunesPocket CastsGoogle Play or Spotify.

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COVID-Like Cough Sent Him To ER — Where He Got A $3,278 Bill

From late March into April, Timothy Regan had severe coughing fits several times a day that often left him out of breath. He had a periodic low-grade fever, too.

Wondering if he had COVID-19, Regan called a nurse hotline run by Denver Health, a large public health system in his city. A nurse listened to him describe his symptoms and told him to immediately go to the hospital system’s urgent care facility.

When he arrived at Denver Health — where the emergency room and urgent care facility sit side by side at its main location downtown — a nurse directed him to the ER after he noted chest pain as one of his symptoms.

Regan was seen quickly and given a chest X-ray and electrocardiogram, known as an EKG, to check his lungs and heart. Both were normal. A doctor prescribed an inhaler to help his breathing and told him he might have bronchitis. The doctor advised that he had to presume he had COVID-19 and must quarantine at home for two weeks. At the time, on April 3, Denver Health reserved COVID tests for sicker patients. Two hours after arriving at the hospital, Regan was back home. His longest wait was for his inhaler prescription to be filled.

Regan wasn’t concerned just about his own health. His wife, Elissa, who is expecting their second child in August, and their 1-year-old son, Finn, also felt sick with COVID-like symptoms in April. “Nothing terrible, but enough to make me worry,” he said.

When Timothy had coughing fits and a low-grade fever from late March into April, his COVID-19 worries weren’t only about himself. He was also concerned for his pregnant wife, Elissa, and their 1-year-old, Finn, both of whom also felt sick with COVID symptoms in April.(Ethan Welty for KHN)

Regan, who is an estimator for a construction firm, worked throughout his sickness — including while quarantined at home. (Construction in Colorado and many states has been considered an essential business and has continued to operate.) Regan said he was worried about taking a day off and losing his job.

“I was thinking I had to make all the money I could in case we all had to be hospitalized,” he said. “All I could do was keep working in hopes that everything would be OK.”

Within a couple of weeks, the whole family, indeed, was OK. “We got lucky,” Elissa said.

Then the bill came.

The Patient: Timothy Regan, 40, an estimator for a construction company. The family has health insurance through Elissa’s job at a nonprofit in Denver.

Total Bill: Denver Health billed Regan $3,278 for the ER visit. His insurer paid $1,042, leaving Regan with $2,236 to pay based on his $3,500 in-network deductible. The biggest part of the bill was the $2,921 general ER fee.

Service Provider: Denver Health, a large public health system

Medical Service: Regan was evaluated in the emergency room for COVID-like symptoms, including a severe cough, fever and chest pain. He was given several tests to check his heart and lungs, prescribed an inhaler and sent home.

What Gives: When patients use hospital emergency rooms — even for short visits with few tests — it’s not unusual for them to get billed thousands of dollars no matter how minor the treatment received. Hospitals say the high fees come from having to staff the ER with specialists 24 hours a day and keep lifesaving equipment up to date.

Denver Health coded Timothy’s ER visit as a Level 4 — the second-highest and second-most expensive — on a 5-point scale. The other items on his bill were $225 for the EKG, $126 for the chest X-ray and $6 for his albuterol inhaler, a medication that provides quick relief for breathing problems.

The Regans knew they had a high deductible and they try to avoid unnecessarily using the ER. But, with physician offices not seeing patients with COVID-type symptoms in April, Timothy said he had little choice when Denver Health directed him first to the urgent care, then to its ER. “I felt bad, but I had been dealing with it for a while,” he said.

Elissa said they were trying hard to do everything by the book, including using a health provider in their plan’s network.

“We did not anticipate being hit with such a huge bill for the visit,” Elissa said. “We had intentionally called the nurse’s line trying to be responsible, but that did not work.”

In an effort to remove barriers from people getting tested and evaluated for COVID-19, UnitedHealthcare is one of many insurers that announced it will waive cost sharing for COVID-19 testing-related visits and treatment. But it is not clear how many people who had COVID symptoms but did not get tested when tests were in short supply have been billed as the Regans were.

Timothy and Elissa try to avoid needlessly visiting the ER because of their high-deductible insurance plan, they say. Denver Health billed $3,278 for Timothy’s ER visit, leaving the Regans with a $2,236 tab based on their $3,500 in-network deductible. UnitedHealthcare officials reviewed his case at the request of KHN, and waived the couple’s cost sharing for the visit.(Ethan Welty for KHN)

Resolution: A Denver Health spokesperson said Regan was not tested for COVID because he was not admitted and did not have risk factors such as diabetes, heart disease or asthma. He was not billed as a COVID patient because he was not tested for the virus. The medical center has since expanded its testing capacity, the spokesperson said.

UnitedHealthcare officials reviewed Regan’s case at the request of KHN. Based on Regan’s symptoms and the tests performed, Denver Health should have billed them using a COVID billing code, an insurer spokesperson said. “We reprocessed Mr. Regan’s original claims after reviewing the services that he received,” a United Healthcare spokesperson said. “All cost share for that visit has been waived.”

The Regans said they were thrilled with UHC’s decision.

“That is wonderful news,” Elissa Regan said upon hearing from a KHN reporter that UHC would waive their costs. “We are very thankful. It is a huge relief.”

Timothy, Elissa and Finn all experienced COVID symptoms. Though they tried to do everything by the book, a trip to the ER for Timothy resulted in a $2,236 tab for the Regans, before their health insurer, UnitedHealthcare, subsequently waived it.(Ethan Welty for KHN)

The Takeaway: The Regans said they initially found no satisfaction in calling the hospital or the insurer to resolve their dispute ― but it was the right thing to do.

“He’s definitely not alone,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. “The takeaway here is both the provider as well as insurance company are still on a learning curve with respect to this virus and how to bill and pay for it.”

Corlette said Timothy should not have second-guessed his decision to use the Denver Health ER when directed there by a nurse. That, too, was the right call.

Insurers’ moves to waive costs associated with COVID testing and related treatment is vital to stemming the outbreak — but it works only if patients can trust they won’t get stuck with a large bill, she said. “It’s a critical piece of the public health strategy to beat this disease,” Corlette said.

To help with billing, she said, patients could ask their provider to note on their medical chart when they are seeking care for possible COVID-19. But it’s not the patient’s responsibility to make sure providers use the right billing code, she said. Patients need to know they have the right to appeal costs to their insurer. They can also seek assistance from their employer’s benefits department and state insurance department.

Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

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KHN’s ‘What The Health?’: When It Comes To COVID-19, States Are On Their Own

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At least so far, states that reopened their economies are not seeing a major spike in cases of COVID-19. But it remains unclear if that is because the coronavirus is not spreading, because the data is lagging or because the data is being manipulated.

Meanwhile, President Donald Trump said he’s taking the controversial antimalarial drug hydroxychloroquine as a preventive measure after he was exposed to a White House valet who tested positive for the coronavirus. Despite the fact that there is no data to suggest the drug works to prevent infection, the president’s endorsement has apparently led to new shortages for patients who take the medication for approved purposes.

This week’s panelists are Julie Rovner of Kaiser Health News, Alice Miranda Ollstein of Politico, Margot Sanger-Katz of The New York Times and Kimberly Leonard of Business Insider.

Among the takeaways from this week’s podcast:

  • As federal and state officials push to reopen the economy, there have been questions about the coronavirus data they are using. Sometimes they combine the number of diagnostic tests — which show if someone is currently infected with the virus — with the number of antibody tests — which show if a person once had the virus.
  • The Centers for Disease Control and Prevention, which has been the lead federal agency in other serious disease outbreaks, is relegated to a backup role on the coronavirus. That points to the difference in trust levels between the public and the White House, which has emphasized the reopening of the economy rather than public health.
  • So much attention is focused on the race to get a successful vaccine. But even if researchers are able to produce one, distribution to millions of Americans will be a logistical problem.
  • Public health officials are pushing hard for Americans to wear face coverings in public, but certain groups are resisting. Polling finds that most Americans don’t object to wearing a mask, but it is a significant change in the U.S. culture and also a key change in public health recommendations. That shift has added to the confusion and may have led to some of the resistance.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: Kaiser Health News’ and The Guardian’s “Lost on the Frontline,” by the staffs of KHN and The Guardian

Kimberly Leonard: Business Insider’s “How Coronavirus Will Permanently Change Healthcare, According to 26 Top Industry Leaders,” by Lydia Ramsey, Kimberly Leonard and Blake Dodge

Margot Sanger-Katz: The Atlantic’s “Why the Coronavirus Is So Confusing,” by Ed Yong

Alice Miranda Ollstein: Politico’s “Politics Could Dictate Who Gets a Coronavirus Vaccine,” by Sarah Owermohle

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