In March 2020, before the world completely changed, Sandy Germain and her husband Joe were at Daytona Bike Week. When they started coming down with cold and flu symptoms, the COVID-19 virus had started to spread in Florida.
They returned home to Naples, and at the advice of their physician, went to the closest hospital to get a COVID test.
“At any other point in history, we would not have gone to the hospital with cold symptoms,” said Sandy Germain, a retired teacher.
When they arrived at Physician’s Regional Medical Center’s south Collier County location, they weren’t actually given a COVID test. The Germains explained that they were swabbed for the flu virus and sent inside for chest X-rays. They claim a physician told them there weren’t enough testing supplies for people with less severe symptoms such as theirs.
However, they were told they had the COVID virus and should go home and quarantine.
“I don’t have a little certificate that says I had COVID, but if I didn’t have COVID, why the hell did I sit inside my house for a month,” said Joe Germain, who said he still has long-haul symptoms from COVID-19.
They fought off body aches, chills, and the symptoms of the virus at their home for the next month. But that’s when something unexpected happened: Bills for the testing started arriving.
First, Joe received a bill that showed his Medicare plan was charged a few thousand dollars for the visit. His out-of-pocket responsibility was very small. But Sandy’s bill indicated that she owed around $1,200 for the ER visit and an additional charge for the physician.
She said a quick call to the physician’s office resolved the charge.
“They said, OK, this is for COVID? No problem, we will resubmit this to your insurance to indicate that,” she recalled. The physician’s portion of the bill was waived, but for the past year, she said she’s been battling with Physician’s Regional to recode the hospital bill.
She said her insurance company told her if the bill was submitted differently, it would be covered at 100%.
However, Physician’s Regional has a different version of events. A spokesperson for the hospital told WINK News that the Germains did not actually receive a COVID diagnosis and that the bill accurately reflects the services performed.
Based on Sandy’s Anthem Blue Cross Blue Shield insurance plan, the bill is what she owes out of pocket.
“We share Ms. Germain’s frustration. As I’ve shared before, insurance companies and employers who provide benefits determine what portion of the bill their members will pay. In this case, Ms. Germain’s insurance determined that she was responsible for her deductible,” wrote Brittney Thoman, the marketing director for Physician’s Regional.
But the Germains contend the only reason their trip to the hospital elevated to an ER visit was because the hospital claimed it did not have enough testing supplies. They only went there for a COVID test, which should have been free.
The federal CARES Act passed last year required that COVID testing be performed with no out-of-pocket cost to the patient. Insurance companies were also required to cover treatment for the virus. Out-of-pocket cost-sharing for COVID treatment and diagnosis was being waived by insurers and hospitals for many months.
According to Jon Hess with Athos Health, WINK”s Healthcare Hacker, insurance companies sort of stopped this grace period of waiving out-of-pocket costs in February. He started hearing from patients at the beginning of 2021 who were receiving bills for their deductibles and co-insurance related to COVID treatment.
By phone, a representative with Anthem Blue Cross Blue Shield said she would try to work something out with the hospital for Germain since the intent of the visit was to get a COVID test. She confirmed that she had previously told Germain that the testing should be covered at 100%. However, Germain’s insurance is not opting in to cover COVID treatment at 100%.
A spokesperson for Physician’s Regional claimed the hospital was not permitted to waive the cost-sharing portion of the bill based on the terms of its contract with the insurance company. But the Anthem representative said that was not true.
As of publication, Germain still has an outstanding bill and neither Anthem nor Physician’s Regional has provided additional information on the status.