A New Item on Your Medical Bill: The ‘Covid’ Fee
A surprise charge that can take advantage of vulnerable people and possibly violate consumer protection laws.
The New York Times is investigating the costs associated with testing and treatment for the coronavirus and how the pandemic is changing health care in America. You can read more about the project and submit your medical bills here.
When Michael Hambley got the call from his 87-year-old mother in July, he was sure there was a mistake. She told him that her assisted living facility, the one she paid for with her pension, was charging a one-time, $900 fee for masks, cleaning supplies and meal delivery.
Jennifer Koeckhoven had a similar experience in June: a $60 personal protective equipment charge — tacked onto her mother’s ambulance bill — that went uncovered by insurance. “She was already wearing a mask,” said Ms. Koeckhoven, who noted that the one-mile ambulance ride already cost $1,759 before the fee.
In New York City, Zariely Garcia was surprised to see a $45 fee tacked onto a dental cleaning in July. It was billed to her directly, not her health plan, a practice that state regulators outlawed the next month as a violation of consumer protection laws.
The coronavirus pandemic has made the practice of health care more costly as providers must wear protective gear and sanitize equipment more often, even as they face declining revenue. Two groups of providers have been particularly hard hit. Dentists have lost billions since patients began postponing nonurgent dental care this spring. And assisted living facilities, grappling with lower overall demand, have also been forced to admit fewer residents to help stop the spread of infection.
To address this financial shortfall, some health providers are turning directly to patients. Surprise “Covid” and “PPE” fees have turned up across the country, in bills examined by The New York Times.
“It’s a complicated answer, who pays for this,” says Scott Manaker, a physician who is in charge of the American Medical Association’s practice expense committee. “You look around the community and see additional costs being imposed right and left because of Covid-19. Barber shops, pedicures and restaurants all have additional charges. It would be an undue burden to ask the medical community to bear this alone.”
Some of these fees — when millions of Americans are reeling after losing jobs and the health insurance that came with it — have drawn the attention of state attorneys general who say that charging patients directly can take advantage of vulnerable consumers or violate health insurance contracts and consumer protection laws. The new charges range from a couple of dollars to nearly $1,000. “The cynical view is that some see this as an opportunity: Everyone understands something unusual is going on, and most customers are ready to embrace the idea they will need to bear some expense,” said Darrin Fowler, an assistant attorney general in Michigan who has been investigating coronavirus fees in assisted living facilities. “Unfortunately, in every setting there are a percentage of folks who will take advantage of that situation.”
The charges appear to be especially prevalent in dental offices, where industry guidelines suggest that fees denied by insurers are “typically billable to patients.” In the spring, millions of dental patients canceled planned cleanings, and offices were shuttered with new stay-at-home orders. When dental workers came back to their offices, they used heavy protective equipment, including N-95 masks and face shields.
The American Dental Association has urged dental health plans to begin reimbursing a new fee to cover the expense. Some health plans have done so, but others haven’t, which can leave patients paying new bills.
Times readers shared new protective equipment fees from dentist offices that ranged from $12 to $45. Insurance companies typically reimburse less, usually between $7 and $10.
Sabine Reichert decided to forgo a dental cleaning after learning she would be charged a $16 protective equipment fee. She would need to submit the claim to her insurance and, because of her deductible, would probably be responsible for the full charge.
“I thought it was ludicrous,” she said. “We have a high deductible, and this year we are saying no to the things we don’t really need.”
Carrie McGurk, a retired lawyer in Boca Raton, Fla., was surprised to see a $15 charge tacked onto her cleaning bill in July. She said she was not informed of the fee in advance, and noticed it only after requesting an itemized bill.
“When I was putting it away in my file, I saw ‘Covid charge’ and thought, Jeez, you could have at least told me,” she said. Because she does not carry dental insurance, she had to pay the full charge.
The American Dental Association “strongly encourages” dentists to disclose any fees to patients, saying the decision to charge the fee is an “individual dental practice business decision.”
Regulators in Connecticut, Maryland and New York have received numerous consumer complaints about new fees at dentist offices. All three states have warned that state and federal laws do not allow in-network health providers to tack on new fees.