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-19 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 about just 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 symptoms like those of COVID-19 in April. "Nothing terrible but enough to make me worry," he said.
Regan, who is an estimator for a construction firm, worked from home throughout his sickness — including while quarantined. (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.
Total bill: Denver Health billed Regan $3,278 for the ER visit. His insurer paid $1,042, leaving him 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-19-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-19 symptoms in April, Timothy said he had little choice when Denver Health directed him first to its urgent care and 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 to 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-19 symptoms but who did not get tested when tests were in short supply have been billed as the Regans were.
Resolution: A Denver Health spokesperson said Regan was not tested for COVID-19 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-19 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 Kaiser Health News. Based on Regan's symptoms and the tests performed, Denver Health should have billed them using a COVID-19 billing code, an insurer spokesperson said. "We reprocessed Mr. Regan's original claims after reviewing the services that he received," a UnitedHealthcare 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 said upon hearing from a KHN reporter that UHC would waive their costs. "We are very thankful. It is a huge relief."
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' move to waive costs associated with COVID-19 testing and related treatment is vital to stem 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 seek care for a possible case of COVID-19. But it's not patients' responsibility to make sure providers use the right billing code, she said. Patients need to know they have rights 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!
MARY LOUISE KELLY, HOST:
If you come down with a fever, cough or other symptom of COVID-19, you are going to be worried about all kinds of things - your own health, the health of your family. Add to that your medical bill. Congress did pass laws in March to protect patients on that last front, and some insurance companies have waived fees. But a trip to the ER can still end in a big bill.
Every month, NPR takes a look at a medical bill. And today we have one for the COVID era. Joining us to talk through it is Dr. Elisabeth Rosenthal. She is editor-in-chief of our partner Kaiser Health News. Hey there. Welcome back.
ELISABETH ROSENTHAL: Hi. Thanks for having me again.
KELLY: Who will we hear from today, and what's the story?
ROSENTHAL: So today we're hearing from the Regan family from Denver. They're a couple with a 1-year-old son and another baby on the way. And the story involves the dad's COVID-like symptoms and an unexpectedly high bill.
KELLY: So our guide to this story is going to be reporter John Daley of Colorado Public Radio. He spoke to the Regans. Let's let him tell us what happened.
JOHN DALEY, BYLINE: In late March, Timothy Regan got sick, hit by symptoms like a low-grade fever.
TIMOTHY REGAN: The coughing was the worst, then the breathing. There was times - I obviously couldn't see myself, but Elissa would see me.
DALEY: Elissa is Timothy's wife.
T REGAN: She got pretty concerned. I couldn't stand up. The coughing fits were so bad I could barely breathe.
DALEY: They wondered, had he developed COVID-19? After being sick for about three weeks, Regan called a hotline operated by a large public health system, Denver Health. He described his symptoms to a nurse.
T REGAN: And they told me that I had to come in within four hours just to make sure I didn't have pneumonia, make sure things weren't worse.
DALEY: When he got to Denver Health's downtown facility, a nurse sent Timothy to the ER because he'd noted chest pain as a symptom.
T REGAN: I was in there for a couple hours, I think, doing tests.
DALEY: Tests like a chest X-ray and electrocardiogram to examine his lungs and heart, which were both normal.
T REGAN: And then the doctor came in and said - yeah, he gave me his diagnosis of - basically without being tested, presumed COVID.
DALEY: The doctor also said he might have bronchitis and prescribed an inhaler to assist his breathing. Because he was presumed to have the coronavirus, Regan was told to quarantine at home for two weeks.
T REGAN: We had to self-isolate. We all self-isolated.
DALEY: At that point, April 3, Denver Health used coronavirus tests for sicker patients, so Regan did not get a test. Soon he was back at home, but the worries weren't over.
T REGAN: I had the sickness the worst. But, like, my wife had symptoms with her being pregnant, and my son had symptoms.
DALEY: They were sick for weeks but all turned out to be fine. Then the bill arrived. Denver Health assessed Regan about $3,300 for the ER visit. The family gets insurance through UnitedHealthcare via Elissa's job at a Denver nonprofit. The insurer paid about $1,000 based on their $3,500 in-network deductible. Elissa says they were left to pay the rest.
ELISSA REGAN: It ended up being over $2,200. I can't remember the exact number now. The amount that I was most shocked by was the visit.
DALEY: The general ER fee.
E REGAN: The visit alone with over 22.
T REGAN: So that big bill out of nowhere just kind of blindsided us.
DALEY: The couple says they'd been trying to do the right thing, only seeking medical care when needed. But when she contacted United about getting the bill readjusted, Elissa was told they were only covering coronavirus tests and nothing else.
E REGAN: We wanted our insurance to be a little bit more responsive to our concerns. So in a moment of kind of frustration, I went in and submitted our bill of the month.
KELLY: Elissa Regan there ending that report from John Daley. So, Elisabeth Rosenthal, I'm in suspense. She submitted the bill. What did we do? What happened?
ROSENTHAL: Well, our reporters started making calls. And the insurer UnitedHealthcare reviewed the bill. Thankfully they said, oh, you're right. This is a COVID bill. And we're going to waive the $2,200. But, of course, you know, there are many problems.
KELLY: Yeah. I mean, it's great news for the Regans, but I am wondering, how is it possible? Not everyone's going to have a reporter calling on their behalf and trying to sort this out.
ROSENTHAL: Sure. We're really concerned that there are more people getting these kinds of bills. You know, insurers and Congress have promised the patients won't be stuck with out-of-pocket expenses, but we're getting lots of bills from people who are. And it's happening in lots of different ways because there are lots of potential loopholes in those promises.
Tim, like so many patients, was told to go to the ER. So the ER fee is a big problem for him. Is that included in the promise? What if, like him, you didn't get an actual COVID test 'cause they weren't testing people who didn't get admitted? Does that count then since there's no documentation that your visits was COVID-related?
KELLY: Yeah. And in this specific case, what was the error or the loophole?
ROSENTHAL: Well, his visit wasn't coded as COVID since he didn't have a test. But, of course, the doctor said, oh, assume you have it, as so many people who are outpatient these days are being told.
KELLY: So what can people do? Because a lot of people are going to be in the same situation - told by their doctor to presume they have COVID even if they don't have an official test result to show.
ROSENTHAL: Right, presumably far more than have had the actual test. So what I tell people, anyone who has to go to urgent care or the hospital ER for coronavirus testing or evaluation, you should look at your bills carefully. And know you have law on your side if you can test them. Also, importantly, tell the provider to note on your chart presumed COVID so when you go back to your insurer and say, hey, this was a COVID-related visit, you have documentation of that. Congress and insurers have made promises, and we really need to hold them accountable for that.
KELLY: All right, Elisabeth Rosenthal, thank you for being with us and telling us about this case today.
ROSENTHAL: Thank you for having me.
KELLY: And if you have an outrageous or confusing medical bill about COVID treatment or anything else, go to NPR's Shots blog and tell us about it. Transcript provided by NPR, Copyright NPR.