RACHEL MARTIN, HOST:
One of the worries associated with COVID-19 is the thought of getting stuck with a huge medical bill. Congress passed laws in March to protect patients, and some insurance companies have pledged to waive copays and deductibles. But as you might guess, there are loopholes. So for our Bill of the Month segment, NPR and Kaiser Health News decided to look at one of those loopholes. Dan Weissman has the story.
DAN WEISSMAN, BYLINE: If you were going to pick somebody to fight a weird medical bill, you could do worse than Anna Davis Abel of West Virginia. She's a grad student, flexible job and no kids. She's got some time to haggle with insurance. And she's got a special qualification. After college, Anna worked in a doctor's office where she haggled with insurance companies for a living. And if you were to pick somebody who really needed a coronavirus test last month, she'd be on your short list there, too. She had just been on a plane, and she has lupus. That's a chronic disorder that means any potentially serious illness poses a special threat. And she had classic COVID symptoms - rising fever and a dry cough that kept getting worse.
ANNA DAVIS ABEL: I had been, like, mainlining Mucinex. I was like, why am I so sweaty? I feel like a man, like, no offense.
WEISSMAN: Anna's doctor said to come in but also said there were hardly any coronavirus tests in the state of West Virginia. To get one for Anna, they would need to...
ABEL: Prove, you know, beyond a reasonable doubt that it was nothing more common and more viral.
WEISSMAN: Anna tested positive for flu. But a week later, her doc was still worried and sent her in for a test. The nasal swab was no fun. Anna documented it on Snapchat.
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ABEL: Oh, my God, that woman took my soul out of my head with that Q-tip. She actually grabbed the back of my head like we were lovers, but instead of kissing me, she was impaling my brain.
WEISSMAN: That wasn't even the worst of Anna's problems that day. Later, she got a statement from her insurance company, Aetna, about that first test.
ABEL: And I was like, you know, this COVID stuff is supposed to be covered. I wonder how that looks. Lo and behold, my insurance company was saying that I owed $536 and I think 47 cents.
WEISSMAN: Actually 46 cents. That was her share, the notice said, of a $2,000 charge for that test.
ABEL: At first, I was like, oh, this is just - you know, they just messed up here. LOL, guys.
WEISSMAN: But when Anna called Aetna and called and called, they said this wasn't a mistake. The billing record didn't include a COVID-specific diagnosis code.
ABEL: And even though my doctor had put in written words, like, this is a part of COVID-19 testing in our state, the person on the other end of the line was not able or allowed - and, I mean, one of them actually said, I'm not allowed to look at that.
WEISSMAN: Anna posted her medical record and the insurance statement to Twitter, which got results - many retweets and a reporter got in touch with Anna and Aetna. That got the company's attention.
ABEL: Within 20 minutes of the reporter emailing me back saying that he had spoken to them, I got a call.
WEISSMAN: And they've since paid her bill in full. Aetna wouldn't go on tape with us. In an emailed response, the company said the information that Ms. Abel's health care provider shared with us initially did not code the service as related to COVID-19. But it's not clear that appropriate codes existed when Anna got her tests. Aetna's statement called Anna's case unique, meaning - and I asked - that no other Aetna customer has had to pay for a test they got in order to get a COVID test. OK.
Meanwhile, legal protections for consumers are a work in progress. Sabrina Corlette runs the Center on Health Insurance Reforms at Georgetown University. She says when Anna got that first test, no national law obligated insurers to cover it. Later in March, Congress passed laws mandating full coverage for COVID-related testing. Would those laws have protected Anna?
SABRINA CORLETTE: Well, this is where I'm going to get super lawyerly on you and your audience is going to just want to, like, shoot me with daggers.
WEISSMAN: Short version - no. The current law only kicks in if a visit includes an order for a coronavirus test even if a test isn't immediately available.
CORLETTE: I would expect most doctors don't know that if they don't actually order a test at the moment of the first visit that their patient could be exposed to these out-of-pocket costs.
WEISSMAN: So, bam, if you get seen for anything that could be COVID, maybe get your doctor to order a coronavirus test whether a test is available or not. Otherwise there could be a loophole and a bill with your name on it. For NPR News, I'm Dan Weissman.
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