The Washington Post - 03.03.2020

A14 EZ RE THE WASHINGTON POST.TUESDAy, MARCH 3 , 2020

THE CORONAVIRUS OUTBREAK

a few instances of people ending

up with large, coronavirus-relat-

ed medical bills have lit up Twit-

ter.

In one case, a 29-year-old Mi-

ami engineer, Osmel Martinez

Azcue, had been in China for

work, returned home briefly,

then flew to Italy for another

quick assignment. By the time he

arrived home on Jan. 27, he said

in an interview, he had spent a

miserable, feverish night in the

Lisbon airport, popping ibupro-

fen as he waited for a connecting

flight.

His mother, who lives in his

apartment building, started re-

searching the coronavirus and

convinced him that he needed a

test.

He t hought it was probably the

flu, but the next morning, he

called an urgent care center,

which told him that only two

hospitals in town could help him.

He went immediately to Mi-

ami’s public hospital, Jackson

Memorial, where emergency

room workers, already alerted,

said they rushed him into a

quarantine room. A nurse in

protective gear quizzed him

about his travels, and a doctor

told him he needed a CT scan,

Azcue said.

He knew the inexpensive in-

surance he had switched to in the

fall requires him to pay $5,

upfront, so he asked the doctor to

first give him a routine flu test,

and, if it was positive for influen-

za, to send him home.

Less than two hours after he

arrived, he left the hospital with

a flu diagnosis and a Ta miflu

prescription.

On Valentine’s Day, a bill ar-

rived from National General In-

surance that upset Azcue so

much that he did not take his

longtime girlfriend out to cele-

brate. It said he owed $3,270.

unless he sent the insurer three

months of records to prove that

the flu had not b een a preexisting

medical condition. After his story

appeared in the Miami Herald,

the insurer withdrew the records

demands late last week, saying

he would owe $1,400.

Said Hopkins’s Inglesby: “It is

in the public interest for us to

have free testing available for

people — not just the test itself

but the process of getting tested.”

So far, doctors are not getting a

lot of calls from worried patients,

said R obert McLean, president o f

the American College of Physi-

cians — the professional associa-

tion of internists — and medical

director of a 400-doctor medical

group in southern Connecticut

affiliated with the Yale New Ha-

ven Health System.

The health system has de-

signed protocols so that “if some-

one is sick with a cough, every-

one gets asked whether they have

been to China” or other outbreak

sites. “If there is any of that stuff,

it gets triaged to a doctor for a

phone call.”

But Scott Becker, chief execu-

tive of the Association of Public

Health Laboratories, said he was

thinking about the health sys-

tem’s capacity the other night,

when his wife wasn’t feeling well

after work with what turned out

to be the flu. T hey went to an

urgent care clinic in suburban

Maryland that was crowded.

“I’m thinking, this place is

busy, and it’s a one-and-a-half-

hour wait now. And we don’t

have community spread here.

What’s going to happen? We are

going to quickly overwhelm clin-

ics,” he said.

Meanwhile, Georgetown’s Cor-

lette said work-related worries

may also deter people from tak-

ing time off to get a test or staying

home if they are sick. She noted

that nearly one-third of all work-

ers — and more than two-thirds

of all low-income workers — do

not get paid sick days.

“Workers who serve our food,

take care of our elderly, take care

of our kids, change our sheets —

that’s a thing that should be

keeping people up at night,” she

said.

[email protected]

Some preparations recom-

mended by the Centers for Dis-

ease Control and Prevention are

incompatible with the way bene-

fits work. Officials have urged

people to keep an adequate sup-

ply of their routine medicines in

case they end up quarantined.

But insurance companies seldom

permit refills until a patient is

nearly out of pills. The agency

also urges people with respirato-

ry illnesses to stay home from

work. But with no federal sick

leave requirements, some ex-

perts predict the virus will

spread more rapidly.

For an international, fast-

spreading epidemic, the nation’s

health-care system and many

workers’ benefits are “certainly

not optimally designed,” said Sa-

brina Corlette, a research profes-

sor at Georgetown University’s

Center on Health Insurance Re-

forms.

Federal funds cover the cost of

the coronavirus test itself when it

is run in federal, state or local

public health laboratories. But

that changes as academic and

commercial labs get involved. In

neither case does the govern-

ment buffer people from bills for

visiting a doctor’s office, urgent

care center or emergency room,

though nearly half of the 160

million Americans with insur-

ance through their jobs have

health plans with high deduct-

ibles.

“Deductibles are designed to

make people think twice about

going to the doctor if they are

feeling sick,” said Larry Levitt,

executive vice president for

health policy at t he Kaiser Family

Foundation, a health-research

organization. “In a potential pan-

demic, the last thing you want

people to do is thinking twice

about going to the doctor.”

America’s Health Insurance

Plans, the industry’s main trade

group, has issued g uidance called

“Keeping Americans Safe from

Coronavirus.” T he statement s ays

insurers are “carefully monitor-

ing the system” a nd working with

the CDC to share information.

But it does not urge insurance

companies to eliminate out-of-

pocket costs for the tests or for

visits to doctors or clinics for

respiratory illnesses, saying that

health plans may want to deter-

mine “whether policy changes

are needed to ensure that people

get essential care.”

Thomas Inglesby, director of

the Center for Health Security at

the Johns Hopkins Bloomberg

School of Public Health, said

eliminating the financial disin-

centive to get tested “needs to be

at the top of the list” of problems

that federal health officials tack-

le.

Inglesby said that other coun-

tries, including Western democ-

racies with government-financed

health-care systems, have not

been fully publicizing their test-

ing strategies. But he said,

“Countries where patients could

get large bills for diagnostic test-

ing will have additional challeng-

es identifying people.”

Even before the test was wide-

ly available in the United States,

exposed — will avoid finding out

whether they have been infected

because they are uninsured or

have health plans that saddle

them with much of the cost of

their care.

Making sure the right people

get tested — and keeping them

away from others if they are

infected — is crucial to help

diminish the virus’s spread with-

in communities as it pops up in a

growing number of states.

Now that federal health offi-

cials have ironed out initial prob-

lems with the test itself and

enabled more labs to take part in

the hunt for infection, this work

of testing and quarantining i s the

essential second stage. Ye t the

government has not yet begun to

tell Americans where to go for

testing, and neither public nor

private insurers are changing

their rules to buffer people from

testing-related charges.

BY AMY GOLDSTEIN

The race to curb the spread of
the new coronavirus could be
thwarted by Americans fearful of
big medical bills if they get
tested, low-income workers who
lose pay if they take time off
when sick, and similar dilemmas
that leave the United States more
vulnerable to the epidemic than
countries with universal health
coverage and sturdier s afety n ets.
As the test for the virus be-
comes more widely available,
health-care experts predict that
some people with flu-like illness-
es — or those who may have been

Worries over medical bills, lost pay could worsen spread

Lack of universal

coverage may make U.S.

vulnerable, experts say

OSMEL MARTINEZ AZCUE

After traveling to China and Italy, Osmel Martinez Azcue went to a Miami public hospital with flu-like

symptoms and wound up with a flu diagnosis, a Tamiflu prescription — and a $1,400 bill.

DAVID RYDER/REUTERS

A swab test for the novel coronavirus at Harborview Medical

Center in Seattle. The test is becoming more widely available.

MD MHIC # 1176 | VA # 2 701039723 | DC # 2 242

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