A vital employee needed a coronavirus check, bought a giant invoice


Carmen Quintero works an early shift as a supervisor at a 3M distribution warehouse that ships N95 masks to a nation beneath siege from the coronavirus. On March 23, she had developed a extreme cough, and her voice, often fast and enthusiastic, was barely a whisper.

A human sources employees member instructed Quintero she wanted to go house.

“They instructed me I couldn’t come again till I used to be examined,” mentioned Quintero, who was additionally instructed that she would want to doc that she didn’t have the virus.

Her main care physician directed her to the closest emergency room for testing as a result of the observe had no coronavirus assessments.

The Corona Regional Medical Middle is simply across the nook from her home in Corona, Calif., and there a nurse examined her respiration and gave her a chest X-ray. However the hospital didn’t have any assessments both, and the nurse instructed her to go to Riverside County’s Public Well being Division. There, a public well being employee gave her an 800 quantity to name to schedule a check. The earliest the county might check her was April 7, greater than two weeks later.

On the hospital, Quintero bought a physician’s notice saying she ought to keep house from work for every week, and she or he was instructed to behave as if she had COVID-19, isolating herself from weak family members. That was troublesome — Quintero lives together with her grandmother and her girlfriend’s mother and father — however she managed. Nobody else in her house bought sick, and by the point April 7 got here, she felt higher and determined to not get the coronavirus check.

Then the invoice got here.

The affected person: Carmen Quintero, 35, a supervisor at a 3M distribution warehouse who lives in Corona, Calif. She has an Anthem Blue Cross medical insurance plan via her job with a $three,500 annual deductible.

Whole invoice: Corona Regional Medical Middle billed Quintero $1,010, and Corona Regional Emergency Medical Associates billed an extra $830 for doctor providers. She additionally paid $50 at Walgreens to fill a prescription for an inhaler.

Service supplier: Corona Regional Medical Middle, a for-profit hospital owned by Common Well being Companies, an organization based mostly in King of Prussia, Penn., which is without doubt one of the largest healthcare administration firms within the nation. The hospital contracts with Corona Regional Emergency Medical Associates, a part of Emergent Medical Associates.

Medical service: Quintero was evaluated within the emergency room for signs in step with COVID-19: a wracking cough and issue respiration. She had a chest X-ray and a respiration therapy and was prescribed an inhaler.

What offers: On that day in late March when her physique shook from coughing, Quintero’s instant fear was infecting her household, particularly her girlfriend’s mother and father, each over 65, and her 84-year-old grandmother.

“If one thing was to occur to them, I don’t know if I’d have been in a position to dwell with it,” mentioned Quintero.

Quintero needed to isolate in a resort, however she might hardly afford to for the week that she stayed house. She had solely three paid sick days and was pressured to take trip time till her signs subsided and she or he was allowed again at work. On the time, few locations supplied publicly funded resort rooms for sick folks to isolate, and Quintero was not supplied any assist.

Carmen Quintero, right, and her grandmother, Teresa Carapia.

Carmen Quintero, proper, nonetheless tries to maintain a secure distance from her grandmother, Teresa Carapia, and two different members of the family over 65. Quintero says she apprehensive about them as she tried to self-isolate with COVID-19-like signs.

(Heidi de Marco/KHN)

For her medical care, Quintero knew she had a high-deductible plan but felt she had no alternative however to observe her physician’s recommendation and go to the closest emergency room to get examined. She assumed she would get the check and never need to pay. Congress had handed the CARES Act just the week before, with headlines saying coronavirus testing would be free.

That laws turned out to be riddled with loopholes, particularly for folks like Quintero who wanted and needed a coronavirus check however couldn’t get one early within the pandemic.

“I simply didn’t suppose it was honest as a result of I went in there to get examined,” she mentioned.

Some insurance companies are voluntarily reducing copayments for COVID-19-related emergency room visits. Quintero mentioned her insurer, Anthem Blue Cross, wouldn’t scale back her invoice. Anthem wouldn’t talk about the case till Quintero signed its personal privateness waiver; it might not settle for a signed normal waiver Kaiser Well being Information makes use of. The hospital wouldn’t talk about the invoice with a reporter except Quintero is also on the cellphone, one thing that has but to be organized round Quintero’s workday, which begins at four a.m. and ends at three:30 p.m.

Three states have gone additional than Congress to waive value sharing for testing and analysis of pneumonia and influenza, given these sicknesses are sometimes mistaken for COVID-19. California shouldn’t be one in every of them, and since Quintero’s employer is self-insured — the corporate pays for well being providers immediately from its personal funds — it’s exempt from state directives anyway. The U.S. Division of Labor regulates all self-funded insurance policy. In 2019, nearly 2 in 3 covered workers had been in most of these plans.

Decision: As lockdown restrictions ease and coronavirus instances rise across the nation, public well being officers say rapidly isolating sick folks earlier than the virus spreads via households is important.

However isolation efforts have gotten little consideration within the U.S. Practically all native well being departments, together with Riverside County, the place Quintero lives, now have these packages, in keeping with the Nationwide Assn. of County and Metropolis Well being Officers. Many had been designed to shelter folks experiencing homelessness however can be utilized to isolate others.

Raymond Niaura, interim chairman of the Division of Epidemiology at New York College, mentioned these packages are used inconsistently and have been poorly promoted to the general public.

“Nobody has carried out this earlier than and a variety of what’s occurring is that individuals are making it up as they go alongside,” mentioned Niaura. “We’ve simply by no means been in a circumstance like this.”

Quintero nonetheless worries about bringing the virus house to her household and fears being in the identical room together with her grandmother. Quintero returns from work day-after-day now, places her garments in a separate hamper and diligently washes her palms earlier than she interacts with anybody.

The payments have been one other fixed fear. Quintero referred to as the hospital and her insurance coverage firm and complained that she mustn’t need to pay since she was searching for a check on her physician’s orders. Neither budged, and the payments labeled “cost reminders” quickly turned “last notices.” She reluctantly agreed to pay $100 a month towards her stability — $50 to the hospital and $50 to the docs.

“None of them needed to work with me,” Quintero mentioned. “I simply have to provide the primary cost on every invoice in order that they wouldn’t ship me to collections.”

The takeaway: Should you suspect you could have COVID-19 and have to isolate to guard weak members of your family, name your native public well being division. Most counties have isolation and quarantine packages, however these sources should not well-known.

Chances are you’ll be positioned in a resort, leisure automobile or different sort of housing whilst you wait out the an infection interval. You do not want to have a constructive COVID-19 check to qualify for these packages and might use these packages whilst you await your check consequence. However that is an space during which public well being officers repeatedly supply clear steerage — 14 days of isolation — which most individuals discover unattainable to observe.

At this level within the pandemic, assessments are extra broadly obtainable and federal legislation could be very clearly in your facet: You shouldn’t be charged any value sharing for a coronavirus check.

Be cautious, although, in case your physician directs you to the emergency room for a check, as a result of any further care you get there might come at a excessive value. Ask if there are every other testing websites obtainable.

Should you do end up with a giant invoice associated to suspected COVID-19, push past a phone name together with your insurance coverage firm and file a proper enchantment. Should you really feel comfy, ask your employer’s human sources employees to argue in your behalf. Then, name the assistance line on your state insurance coverage commissioner and file a separate enchantment. Press insurers — and massive firms that provide self-insured plans — to observe the spirit of the legislation, even when the letter of the legislation appears to allow them to off the hook.

Invoice of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical payments. Do you could have an attention-grabbing medical invoice you need to share with us? Tell us about it!