Walecia Konrad, CBS News

When Grace Thomas ran a high fever and had trouble breathing in March, she headed to the emergency room. With a history of asthma, the 26-year-old Denver resident was familiar with respiratory distress, but this was different.

Both the ER doctors and Thomas suspected COVID-19. Yet while Thomas was experiencing symptoms of the disease, including severe pain in her lungs, she didn’t receive a test for the virus. The reason: Thomas was never officially admitted to the hospital, so she didn’t qualify for one of the sought-after tests, which the hospital at the time was limiting to patients who had been admitted. Instead, Thomas was stabilized by ER staff and sent home to recover with a fistful of prescriptions.

Weeks later, Thomas is feeling much better, but is now dealing with a new problem — sorting through the bills from her ER visit to determine what she owes. The financial hit from her COVID-19 treatment is part of the impact of the coronavirus, which has not only infected about 1.4 million Americans but also left many with heavy medical bills.

And plenty of stress — it’s often unclear who is on the hook for paying for coronavirus treatments. That’s especially true for patients like Thomas, who weren’t able to get tested for the disease when they initially sought medical care.

“I’m still sorting through everything and trying to figure out what might be covered under new COVID rules and how it’s all going to work out,” she said. “This ER bill is pretty huge.”

Thomas said she got a “not very well itemized” statement from her in-network hospital, which shows about $1,200 in coinsurance charges for her ER treatment. Co-pays from prescriptions add another $200 to her costs. She expects she’ll also owe a $500 co-payment for any ER visits, although she hasn’t yet found the bill for that. And she wonders if she’ll be on the hook for two telehealth follow-up doctor visits.

Treatment costs could top $20,000

Exactly what’s covered by insurance for COVID-19 patients with out-of-pocket health care costs is a mystery to plenty of patients like Thomas. The patchwork of initiatives from the government and health insurance industry may create as much confusion as relief for consumers.

“I wish there were a federal law that said it was illegal to give a bill to a patient during all this,” said Karen Pollitz, senior fellow at Kaiser Family Foundation. “But it all depends on who is taking care of you.”

Costs for patients hospitalized for COVID-19 may reach $20,000 per person, while individuals can expect to pay an average of at least $1,300 in out-of-pocket costs, according to a Kaiser analysis. Even patients who aren’t hospitalized may still face pricey medical bills for outpatient treatments, testing and ER visits that don’t end in hospital admission, health advocates said.

Fear of racking up heavy medical bills may be keeping at least some people from seeking COVID-19 treatment. About one in seven adults said they would avoid seeking medical care for a fever and dry cough due to concerns about costs, according to a recent study from Gallup and West Health.

“Broken” system

Dozens of insurers, including Aetna, Cigna and Humana have waived some combination of co-payments, co-insurance and deductibles for COVID-19 treatments including hospital stays, according to America’s Health Insurance Plans, a trade group. But these waivers vary in what they cover, and not all people with insurance may be eligible.

In many cases, these waivers apply to treatment from out-of-network providers — an important consideration for patients in hard-hit areas where it may be impossible to limit your options to in-network care. Bills for out-of-network services are often the cause of surprise medical expenses.

Before the outbreak, several members of Congress were working on ways to eliminate surprise billing. Now, several patient advocate groups are encouraging lawmakers to deal with the issue for all patients in the next stimulus bill.

The pandemic “shines a bright light on just how broken our health system is,” said Emily Holubowich, vice president of federal advocacy for the American Heart Association. Patients with heart disease are at much higher risk for serious complications from COVID-19 and, in turn, expensive medical bills.

Some waivers took effect in late March while others start April 1. Some have waived cost-sharing for virtual doctor appointments by video or phone, yet other plans still require patients to meet their deductible before covering those consultations. Insurers also have varying definitions of what COVID-19 treatment actually means. (To find out your insurer’s rules check this list or call directly.)

Pollitz of the Kaiser Family Foundation notes another important caveat: Even if you think you have insurance from one of the companies offering cost-sharing waivers, you may not be eligible. That’s because most employer-sponsored plans are self-funded and set their own rules about coverage. Insurers simply administer the plans.

“You may be carrying a Blue Cross Blue Shield card in your pocket, but if your employer decides not to pay, you’ll get hit,” Pollitz said.

On the hook?

Thomas said she worries she’ll be on the hook for the full amount of her cost-sharing for the treatment she received. That’s because she visited the ER on March 24 and her insurer is waiving out-of-pocket costs only for COVID-19 treatments that began on April 1. She also expressed concern that, because she was never tested, she can’t prove she was treated for COVID-19 even if it is possible to negotiate an exception on the date with her insurer.

Patient advocates say stories like Thomas’s are just the beginning of what promises to be a flood of questions, complaints and appeals concerning COVID-19 coverage.

“It takes weeks for medical bills to show up, especially from out-of-network providers,” explained Adam Fox, director of strategic engagement at the Colorado Consumer Health Initiative.

With COVID-19, meanwhile, it may take even longer as hospitals wait to see how much they will receive from existing and future government stimulus packages and how much of that will be used for compensating out-of-network providers, Fox predicted.

Follow the bouncing bill

Under the Coronavirus Aid, Relief and Economic Security Act, passed in late March, hospitals that receive emergency funding are prohibited from billing patients for fees beyond their network reimbursement rate.

“But that will be difficult for patients to track,” Pollitz predicted.

The Trump administration has mandated that all comprehensive health insurance plans must pay for 100% of the cost of coronavirus testing as well as the visit to the ER, doctor’s office or urgent care center that may have led to that testing. Definitive as that sounds, however, there are gray areas.

Take 25-year-old Anna Davis Abel of Morgantown, West Virginia, who has lupus, an immune disease that may make her more susceptible to coronavirus complications. Tests for COVID-19 were scarce when she came down with similar symptoms in early March. Her doctor decided to first rule out other respiratory illnesses, testing her for the flu and other common viruses.

The tests found that Davis Abel in fact had the flu. During her recovery, she received a co-insurance bill for more than $500 for the test and the doctor visit. Davis Abel and her doctor both believe the test should be covered completely as a cost related to COVID-19 testing, an argument the doctor made in writing.

“I thought to myself, ‘How on earth can this not be covered?'” Davis Abel told CBS Moneywatch.

After some unsatisfactory calls to her insurer, She took her case to social media, where it was picked up by media outlets. Ultimately her insurer agreed to pay the full amount.

Said Davis Abel, “I hope other people with COVID-19 bills don’t have to fight this hard.”

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