The Washington Post - 03.03.2020

(Barré) #1



a few instances of people ending
up with large, coronavirus-relat-
ed medical bills have lit up Twit-
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
His mother, who lives in his
apartment building, started re-
searching the coronavirus and
convinced him that he needed a
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
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
[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-
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-
“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-
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.


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

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.

A swab test for the novel coronavirus at Harborview Medical
Center in Seattle. The test is becoming more widely available.

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