Throughout the coronavirus epidemic, Congress, providers, and insurers have taken steps to mitigate Covid-19 patients' financial strain—but policy gaps have left many patients vulnerable to so-called "surprise" medical bills, Sarah Kliff reports for the New York Times' "The Upshot."

The surprise billing legislative landscape: What can we learn from states' experiences?

A $52K air ambulance ride

When a 60-year-old intubated Covid-19 patient started rapidly declining, doctors told her family she needed to be airlifted to a hospital in Philadelphia, 20 miles away. "It's life or death," the woman's family said they were told. "We have to transfer her now."

The woman, who asked not to be identified as she recovers, was flown to the hospital by a Conemaugh Medstar helicopter. Conemaugh Medstar is owned by Air Methods, one of the largest air ambulance services in the country, which is owned by the private equity firm American Securities.

The woman was treated at the hospital for six weeks before being discharged to continue her recovery at home. But shortly after her return, she received a bill—$52,112 for her air ambulance trip, Kliff reports.

The woman's health insurer, Independence Blue Cross, originally said it would pay $7,539 of the bill but then rescinded the money, Kliff reports, leaving the patient with the full bill.

"She was intubated and on a ventilator when her providers felt it was necessary that she be transferred," Leslie Pierce, a division chief at the Pennsylvania Insurance Department, who handled the patient's complaint, said. "She had no decision in the selection process."

The insurer has since begun reprocessing the claim, and, according to Kliff, plans to cover the bill in its entirety.

Why patients are getting hit with surprise medical bills

Last year, Congress was working to pass legislation to eliminate surprise billing. However, those efforts stalled toward the end of the year, and before Congress could resume negotiations on a plan, the new coronavirus epidemic began.   

During the early days of the epidemic, Congress attempted to address the potential financial burden of Covid-19 by passing relief packages that provided billions of dollars in funding to help hospitals and providers caring for patients. Congress also began reimbursing hospitals at Medicare rates for treating uninsured Covid-19 patients and making coronavirus tests available to Americans at no cost. Many insurers, meanwhile, waived out-of-pocket Covid-19 treatment costs for their members.

But Kliff reports that those protections left "significant gaps." For instance, Kliff reports, some providers did not receive Congress' relief funds and have continued sending out-of-network patients surprise medical bills, while many insurer policies covering patients' coronavirus-related hospitalizations do not fully cover ambulance—or air ambulance—rides to the hospital or follow-up care to treat long-term symptoms. The Times has asked readers to share their medical bills for coronavirus-related care, and so far, the database has more than 350 submissions.

For instance, Lynne Lerner, a Covid-19 patient in California, was stuck with two bills for $1,471 from the Los Angeles Fire Department for ambulances that took her and her husband from their house to a hospital one mile away.

Lerner said she had expected her insurance would cover all coronavirus-related costs, but instead she was stuck with a $294 bill for her ambulance ride after insurance.

"They took us around the corner," Lerner said. "I could have walked."

Alice Navarro spent 10 days at an in-network hospital with Covid-19 in July. However, during her stay, she saw a number of doctors at the hospital who happened to be out-of-network, Kliff reports, and as a result, her health plan has left her with around $4,000 in charges.

Navarro, who is currently suffering from short-term memory loss as a result of Covid-19, has filed appeals with her insurance.

"I think about the bills several times a day," Navarro said. "How am I going to pay this all off? My parents were like, 'Don't worry about this right now, focus on getting better,' but that's easier said than done" (Kliff, "The Upshot," New York Times, 10/13).