If I get COVID-19, what good will my insurance do me?

Dan: Hey there. How you doing? Round here at my place? That answer is a minute by minute thing, and we are incredibly lucky. Three people, all healthy, knock wood, who really like each other, knock wood, a cat we all adore. There’s food on the table.

Grownups who are used to working from home and a grocery store that lets us order in advance and brings the bags out to our car. I mean, it’s different. We’re not used to running a homeschool here. Too much less a homeschool cafeteria, and we are definitely not used to all being on top of each other all the time.

And the store seems to be outta flour and butter and chocolate chips. So that’s gonna require an adjustment. And the jobs are different. Me, I wasn’t planning on bringing this show back until June for season four. Now we are figuring out how to do it every week for as long as it takes. We’re calling it season 19, like COVID-19,

but I am really, really glad to be able to make this show, to stay connected with you, to use whatever my skills are in a way I hope will be useful. And to both of those ends, I’ve been asking you for your questions and your stories, and as usual, you have been coming through so. Let’s go. This is an arm and a leg.

A show about the cost of healthcare. I’m Dan Weisman. This week we’ve got a question from Becky in Minnesota. She wants to know, is my insurance gonna do me any good if I get sick? She says, right now she’s doing fine. In a weird way, she and her husband work from home. The business they run is still going.

When we talked last week, she didn’t think the virus had directly hit anybody She knew. Mainly she wasn’t seeing her adult son, even though he lives just a mile away. He and his roommates are outta work and she says they’re in a kind of limbo and in a way, so is she. She’s aware of what’s coming, but she’s not living with it yet.

Becky: And that period between knowing intellectually and responding. With your life is a very strange moment to live in,

Dan: so she’s trying to get prepared, like thinking about insurance. She’s got a bronze plan, it’s got a $6,000 deductible, and it only covers her in certain places.

Becky: It’s always been sort of a trade off that we’ve had to adopt in order to get the premium down to a level that we can afford.

Dan: Yeah.

Becky: But that, but the trade off is wow. You know, be, be really careful because this policy that you think is going to cover some emergency situation, it may not cover it at all. Yeah. That’s always made me a little nervous, but with. Cvid, 19 then. Then that sort of lurking question in the back of my mind became.

A little more urgent to me. Urgent. If you call an ambulance, you may not even go to a hospital, right? Let alone a hospital that is quote unquote in your network.

Dan: Yeah. So Minnesota Governor Tim Walls recently announced contingency plans to take over sports arenas to serve as temporary hospitals if there’s a big surge.

And around the same time, his office announced an agreement with the big insurance companies, no copays or deductibles for COVID-19. As long as you are in network. I mean, what’s the chance that US Bank Stadium slash hospitals gonna be in network for anybody?

Becky: It was such a disconnect. Oh, and, and the cost will be covered through May 31st, so, right.

If you require any sort of care after that. Huge question mark. Yeah. Whew. Yeah.

Dan: I set up a call with one of the country’s top health insurance nerds. Sabrina Corlett is the founder of Georgetown University’s Center on Health Insurance reforms. If anybody has an answer to Becky’s question, Sabrina’s gonna have one.

And Sabrina’s like, okay, we gotta start at the beginning. Start with charges for testing, and right away there’s questions. So a law Congress passed in March says, testing gets covered. Now there are some. Loopholes

like number one, testing is only covered under that federal law. If you’re going to a place that’s covered by your insurance, that’s in network, then the law says, yeah, no worries about copays and deductibles and stuff.

What if you’re out of network? Uh, that depends and it’s complicated.

Sabrina Corlette: Uh, bear with me a moment because Minnesota I believe has a law that. Hang on one second.

Dan: Oh, and then Sabrina asked, uh, is this a PPO plan or an HMO plan? Because

Sabrina Corlette: in Minnesota you have a bifurcated, uh, regulatory structure,

Dan: meaning two different state agencies oversee the different kinds of insurance plans.

I tell Sabrina, Becky’s got a PPO plan, and she’s like,

Sabrina Corlette: it might be worth checking with the Minnesota Department of Commerce, which is the. Relevant regulatory agency here.

Dan: Oh man. Okay, so let’s just review this a little bit. It sounded like you were consulting stuff on the web, checking your facts. You’re an expert, and you’re like, okay, so, oh God. 

Sabrina Corlette: Yeah this is so complicated, right? I mean, I study this stuff seven days a week, every waking working hour. I don’t know how anybody who you know, doesn’t have a PhD in insurance would just sort of know this stuff.

Dan: Yeah. And remember we’re still just talking about testing. We haven’t started talking about treatment yet, and actually we’re not ready to, before we leave the testing.

Mm-hmm. Um, there have been reports of people who went in and were tested and tested first for the flu, and they turned out to have the flu and they were sent home and they got giant bills.

Sabrina Corlette: Right.

Dan: Is that still a

Sabrina Corlette: thing? So the federal law does not protect you if other tests are ordered, uh, whether it’s the flu or a CT scan or something else to rule out another condition.

Dan: So you go in for a COVID test and they’re like, yeah, here’s a flu test first, and you’ve got the flu. So you don’t get a COVID test. Yes, you’re still on the hook.

And then there’s this…

Sabrina Corlette: because we have, um, such challenges with testing capacity, another. Scenario that I’m hearing is fairly common is that you go to ask for a test ’cause you think you have some symptoms and they tell you to come back only if your symptoms get worse, or you have, you don’t check all of the boxes on the symptoms.

You know, maybe you have the fever and the dry cough, but you don’t have shortness of breath. And they’ll say, well just come back later if this symptom pops up. Under the federal law, there is no protection if a test is not actually ordered.

Dan: You show up for a test and don’t get one. And at this point, that is pretty common in lots of places.

They can only do so many tests. You don’t qualify. You could get hit with a bill for the visit. If you’re at an ER or an urgent care center. You could get charged a facility fee, like a cover charge, and those can be hundreds, even thousands of bucks on their own. I double check this with Sabrina, this federal law that says like, you don’t get charged for the test.

That doesn’t apply. ’cause you didn’t get a test. Right?

Sabrina Corlette: Exactly. 

Dan: man. So that’s testing. Yes. But then what she’s really talking about is what if I need treatment in the middle of a surge? I don’t think anybody is gonna be consulting my insurance policy, you know? If you’re being taken to the hospital at US Bank Stadium, it’s very unlikely that your insurance covers US Bank Stadium Hospital.

’cause that hospital didn’t exist when that policy was written. Yeah,

Sabrina Corlette: yeah. No. Um, and that’s why we have seen a number of states require carriers to cover out of network care if the patient is unable to access in-network care on a timely basis. I. Don’t recall offhand if Minnesota is one of those states.

Dan: I don’t think it is. So one of the things you’re saying here is like, yeah, that’s a super big concern and some states have addressed it. Other states not so much.

Sabrina Corlette: Right. 

Dan: And then there’s, and again, only

Sabrina Corlette: for fully insured or state regulated plans.

Dan: Yeah.

Sabrina Corlette: The state level protections would not kick in if you’re in a self-funded employer plan.

Dan: Yeah. Let’s unpack that and put that in English, right? Yeah. So that, that’s, we’re getting into the fine print. Like, okay. Your state made a rule that said even if we have to take you to an improvised hospital at the sports arena. You’re wherever it is in in network or outta network if your insurance normally covers it or not.

Yeah. You’re covered. Um, and you’re saying, yeah, that’s only true for insurance plans that states regulate. And it turns out the figure I’ve seen is 61% of people who get insurance from their jobs. Right. Have insurance that where the states don’t have any say in regulating it. Right? Because they do this thing called self-insurance.

And in a nutshell, self-insurance means your employer is the insurance. So they hire a company like Blue Cross or Cigna or whatever to process claims. So you get a card that says Blue Cross or Cigna or whatever. But when it’s time to actually pay a claim. Your employer is paying it. I run a version of that by Sabrina to check,

Sabrina Corlette: right?

So most of us with employer coverage are in self-funded plans and to date anyway. There have been no federal requirements. That would mean that those plans have to cover out of network treatment for COVID-19.

Dan: Okay, so, so, so the answer to the question here, I mean, the answer right away, right? The answer to the question here is it’s complicated. It depends. How big of a nerd are you? Like if we wanna get an answer for any individual person,

Sabrina Corlette: right. And yeah. And you really have to self-advocate and get yourself smart before the services occur and, and it’s actually really hard to get yourself smart.

So I’ll just, my personal example, my daughter had to have minor. Outpatient surgery a couple of years ago, and I wanted to know if the anesthesiologist would be in network. Um, because I study health insurance and I know if the anesthesiologist is out of network, I could get hit with a really big bill

Dan: and you know that, that anesthesiologists are often out of network.

Right? That that’s a short spot.

Sabrina Corlette: Yes, and it took multiple calls. I, and actually on the day of the procedure, I didn’t, I, I still didn’t know the answer to whether the, the anesthesiologist in the hospital on the day of my daughter’s surgery would be in or out of network.

Dan: I think it’s fair to say that there is probably.

No one in a better position to be smart and self-advocate than you.

Sabrina Corlette: You know, you would think so, but I do think there’s, even for the most informed people, there’s a natural reticence to sort of be that, you know, pain in the butt that you sometimes need to be to protect yourself financially.

Dan: And that’s under kind of ideal circumstances.

And uh, and we’re looking at the possibility of. E extremely not good circumstances, right? Being gravely ill in the middle of a pandemic.

So look, I try not to let this show be a complete downer. We’ve all got enough of that and in fact, I did get some useful information from Sabrina and actually some really helpful, thoughtful advice from Becky who asked this question to begin with. We’ll be right back with that after this.

This season of an Arm and a leg is a co-production with Kaiser Health News. Kaiser Health News is an independent newsroom reporting on healthcare in America. It is not affiliated with the giant healthcare provider, Kaiser Permanente.

There’s a little more detail about that at the end of the show.

Okay, so useful information. This is for anybody you know who’s suddenly outta work, like Becky’s son and his roommates, Sabrina helped me understand the options a little more clearly. A couple of them I knew, ’cause I’ve been making this show for a couple years now. I’m that kind of nerd. And for the third, probably the most useful one.

She helped me understand some big details a lot better. So first, if you leave a job, a federal law called Cobra may allow you to pay your old employer to stay on their policy. You’d be paying the whole premium, which can be a lot, especially if you’re out of a job, but it’s a thing. Second, you could buy health insurance on an Obamacare exchange.

Even when it’s not open enrollment, losing your job and your health insurance gives you the right to do that, but you know that also costs money and you just lost your job. So I ask Sabrina about the third option. If you suddenly don’t have any income, could you apply for Medicaid? That’s, that’s, that’s like government funded health insurance for people who don’t have a lot of income.

That sounds like it would be a thing

Sabrina Corlette: If you, if you live in a state that expanded Medicaid.

Dan: Huh? What if I live in a state that didn’t expand Medicaid, but you know, I suddenly don’t have any income?

Sabrina Corlette: Well, um, if you have dependent children, it’s possible that you could qualify. The rules there vary state to state, but if you are a single adult with no dependents, you would generally not qualify for Medicaid unless the state has expanded it.

Dan: On the bright side, she says most states have expanded Medicaid, so single childless adults can qualify in those places.

Sabrina Corlette: Yeah, absolutely. Um, if, if your income’s dropped to zero or you know, anything up to 138% of the federal poverty line, you can get into Medicaid. And it’s, it, I mean, it’s comprehensive coverage with almost no premiums and almost no cost sharing.

So it’s a pretty good deal.

Dan: Which leads me to think, I would imagine, like, oh man, the, the Medicaid application offices must be. Jammed. Oh, they’re swamped. Yeah,

Sabrina Corlette: yeah, yeah. No, they’re, they’re, yeah. They’re just overwhelmed. Um, yeah. Whew.

Dan: Okay, so be prepared to wait. Yes. Yeah, so I looked up the numbers. 37 states have expanded Medicaid that includes the entire Northeast, everything west of the Rocky Mountains, a lot of the Midwest, other states too.

We’ll have a link to a map at arm and a leg show.com, and the rules in other states vary. I mean, bottom line, if you’re outta work or have a lot less work, go apply for Medicaid. This could actually be useful for Becky’s 30-year-old son in Minnesota or millions of other people. But for Becky, herself or anybody else wondering what your regular insurance will cover, my take away from an hour on the phone with one of our country’s top insurance nerds is go figure.

It’s complicated and honestly, the outlook is not that great. Which left me with another question for Sabrina. What is this moment like for you? You’ve been studying health insurance and the laws that govern it. You’ve been watching that and you’ve been watching how it affects regular people, and now we’re in the middle of we’re, or we’re getting into the middle of, some of us are in the middle of it, some of us are watching it come, you know, this giant surge that makes all of these questions super immediate for everybody all at once.

How does that feel and what does it leave you thinking?

Sabrina Corlette: Oh gosh. Um, I, you know, I. Stink every day about how our system is, is, is failing people. And the sort of byzantine nature of it, um, has always meant that some of our most vulnerable people fall through the cracks. I think it’s compounded now by, you know, the very people that.

Are sort of keeping our society functioning right now, whether it’s bus drivers or grocery store workers, or the people that are delivering things to our homes. You know, these are the people most likely to have no health insurance or inadequate health insurance. You know, they’re also the ones most likely to have a bad outcome if they do get sick.

So, I mean, God, what am I feeling right now? I’m feeling scared. A lot sort of for where we could end up at the close of this epidemic if we ever get in front of it. I don’t have confidence in our federal government in the short term anyway, to respond and to provide the essential safety net for these folks.

And I, I really worry, uh, about. The fact that, you know, not only are a lot of these folks gonna be struggling financially because we’re in this massive economic crisis, but if they get sick, um, there’s just, you know, in, in most states, there’s just very little, little protection for them. So I, I think my predominant emotion these days is, is fear.

Dan: When you say fear of where we could end up, what’s the image? What are you, what are you imagining?

Sabrina Corlette: Uh, um, I worry that we’re, what are we now at 17 million people who don’t have jobs, and a lot of those people have lost their health insurance along with those jobs. I worry about. A lot of really desperate people, and it’s not just about worrying about their healthcare bills, like in terms of the hierarchy of needs that may not be the primary one.

It’s getting food on the table, housing, all that kind of stuff. And then I worry, you know, as we sort of are in this moment, I feel like we could go in in almost one of two directions. One is fairly dystopian, quite honestly. Um, and the other is more hopeful, you know, where there’s a greater recognition that we need a government safety net.

I think we could come out of this crisis with a greater recognition that we owe more to each other as a society. But the alternative vision is, is a really scary one. And I just, I just don’t know, um, uh, which of those two paths will end up going down?

Dan: It is sobering like a lot of people, I guess I’ve been thinking about that book The Plague by Albert Camu. I read it a long time ago. You know, the Bubonic Plague hits an island city and the main characters are a few people whose jobs are to keep people from dying. The one I remember is a doctor who was just about to go on vacation before everything got locked down.

It is. Harsh. These characters do everything they can, but they know there’s gonna be an overwhelming amount of death that they cannot stop. And as the book goes on, all that death happens and it doesn’t stop. But they refuse to stop doing what they can. It’s awful and it is absolutely their best option. I haven’t been able to get myself to reread that book and I’ve given it a shot, but I have read a couple things about it and one thing I learned, something that everybody else seemed to already know is that Camu had a kind of specific metaphor in mind.

He wrote the plague after World War ii, and he had spent a lot of that time working with the French resistance to the Nazis. So I’d been thinking about the struggle in that book as just like about a literal disease that he was thinking about, politics, war, society, all of it. Stuff that’s bigger than any of us.

We have to decide how we are gonna respond when Sabrina Cort talks about what path we’ll take as a society. That’s what I think about. And some of this stuff, a lot of it is gonna be out of our control. Nothing we can plan for. But Becky, you can kind of tell she’s the kind of person who thinks ahead. She is making the best preparations she can and not just about health insurance.

We talked about it and that was sobering too, but it was, it was good. She said a few weeks ago she started making some preparations.

Becky: I went through all of our. Sort of personal life records. Mm-hmm. Made certain, everything was in order, made certain everything was. Was clear to our grown son. Mm-hmm. Because I do all of the financial stuff.

So it really was like, oh man, this is all in my head and I, and I have to get it out. If I’m leaving, I have to leave these guys like a fighting chance of understanding where we, you know, where things are when it first emotionally hit me. What this virus could mean to this country. That was the point at which I went, okay, you have to find a way of getting this info outta your head.

Mm-hmm. And so I just did a little bit every day, you know, and I kind of said to myself, if you, if you only get this one question. Today. That’s okay. Mm-hmm. So it’s taken, you know, two, three weeks. And I still think of things like, oh yeah. You know, so I just, I just add to the list then, you know, and I think we have to be very, like, gentle with ourselves.

Mm-hmm. And understand that. That isn’t the switch you can flip. Yeah. That’s more sort of a, a Lego house that you build and you get, if you get a break on every day.

Dan: yeah.

Becky: You’re doing a good job. You know?

Dan: Yeah. It’s a lot, but it is really good advice. Do the hard work, but be as gentle with yourself as you can.

Thank you so much for taking this time to talk with me.

Becky: Well, thank you. I mean, I, I really appreciate the show. It’s been, it’s been super helpful.

Dan: Glad to hear that from a

Becky: from a sanity perspective, you know, even when it’s like, this is not my problem specifically. Right. But it’s like, oh yeah. We are all being made slowly crazy.

Yeah. By a system that is not designed with us at the center. Yeah. And so it’s just been helpful to like. Be able to commiserate and also hear, here’s some solutions, some possible things, you know, you never know when you’re gonna need info like that. So it’s great to to know that it’s out there in case you have to go do battle.

Dan: That’s right. Thank you so much. It’s really, really nice to hear. Have a great day. I realize I’ve kept you a few minutes past when you said your window was, I hope I’m not leaving you scrambling. Um, nope.

Becky: It’s okay. The dog understands. Okay. It’s really the dog’s window.

Dan: Okay, good. Good, good, good. Well, uh, tell thank you.

Give, give him my apologies. Okay. Bye-bye.

Becky: Thanks. Bye-bye.

Dan: Uh, hey, wait. A funny thing, remember how in the first half of this episode, Sabrina Cort answered Becky’s main question, which was, what if I get sent someplace that my insurance doesn’t cover? And the answer was, oh man. Good luck. It turns out, as we were about to release this episode, that answer changed one of the stimulus bills that Congress passed in March included some money for hospitals, and on April 13th the Feds issued new guidance for hospitals that take that money.

So I called Sabrina Corlette again. Alright, so we’re in, uh, we’re in new territory. There’s some new federal guidance. Is that right? Okay. Yes. And, and just to, just to get this right, mm-hmm. When we talked last week, the bottom line was like. Good luck. Um, right. I mean, nothing that we had seen at that point provided any protection, but now it sounds like things are a little different.

Is that right?

Sabrina Corlette: Yes. If you are in a hospital that is receiving this provider relief. Money you have to agree that you will not balance Bill COVID-19 patients.

Dan: And just for those of us who are not fluent in healthcare, nor balance billing is, um, somewhat better known to some people as surprise billing. And it, it’s basically what happens when you’re seen by somebody who doesn’t happen to take your insurance and they’re like, surprise, we thought we should get paid X.

Your insurance paid us. Y. We want the balance from you, and that’s whatever we say it’s, and that is the exact sort of thing that Becky is concerned about. And so you’re saying if hospitals are taking this federal money, then they have to agree like, no, I’m not gonna bill Becky for whatever. Is that right?

Sabrina Corlette: Right. So if she is getting COVID related treatment, they have to take whatever they’re getting from the private plan as full payment under this guidance that came out yesterday. Huh. Um, I will say. Um, not, you know, I feel like I’m always the Debbie Downer at the party, but, um, it’s not totally clear that, that the patient is a hundred percent protected.

So, for example, while the hospital might take the funding and then be committed not to balance billing, it’s not clear that other. Physicians that work in that hospital would be bound by this agreement. So for example, if you needed anesthesia services, the anesthesiologist might not be getting this federal funding, in which case they would not be bound by the agreement not to balance bill or surprise bill to patient.

Dan: So, cause the anesthesiologist or any other doctor for that matter, is probably not an employee of the hospital, so they’re sending their own bill.

Sabrina Corlette: Yeah. Exactly.

Dan: And so it’s up to that doctor to decide, are we gonna take this federal money? And that federal money, it sounds like, can go to individual doctors or practices, is that right?

Yes,

Sabrina Corlette: that’s right.

Dan: All right. Whoa. Okay. So it still sounds like it’s kind of complicated. Potentially.

Sabrina Corlette: It is. And I would say too, to that point, I don’t see anything in this that requires the provider to upfront notify the uninsured patient or the insured patient, Hey, we’re a recipient of this federal funding.

Here’s what your rights are, here’s what we’ve agreed to, and you know, here’s what recourse you have. If you don’t like. The results,

Dan: right? So they could just like forget to tell you and then they could send you the bill for whatever they want to bill you for. And if you don’t happen to know that they’ve got this deal with the federal government, well just collect your money.

Who would’ve thought that healthcare could be so complicated? Um, so, so how unusual is it for you to have these kind of giant. Policy changes kind of coming like, oh, and then it, then this happened on Saturday and then, and then there’s this new guidance as of Monday and hey, it’s Tuesday. How unusual is that for you?

Sabrina Corlette: Well then add on top of that the 50 states that are putting out new guidance every single day. Um, so it’s, uh, it’s a little overwhelming.

Dan: Okay. Wow. So this is not like the usual for you.

Sabrina Corlette: I hope not. My God, I, yeah. Um, you know, on the one hand, um, the, you know, being so occupied with tracking all this and staying on top of it is keeping me somewhat sane from the, you know, and, and distracting me from the fact that I can’t leave my house.

Mm-hmm. So that is the upside. All right.

Dan: Well, we’ll take it where we can get it. Thank you so much. Thank you. Sure. Okay. Yep. No problem. Okay. Take care. Bye-bye.

Sabrina Corlette: Bye-bye.

Dan: And thanks to you for listening and for sending in your stories and questions. I’m thinking we should have a whole episode soon to share a bunch of what I’m hearing from you.

A lot of it is really inspiring and some of you are in situations that sound pretty scary for now. Here is a note that came in on Saturday from Grant in South Jersey. Hey, just listened to the show. I have three friends plus myself, 3D Printing, PPE, and other supplies delivered about a hundred pieces after launching Tuesday.

I’ve never printed in my life, but I’m a producer, editor and figured I would figure it out. Forgive my grammar. I’m driving deliveries right now. And dictating to my phone. Grant, thank you and I hope you are staying safe also, next time if you want, you can record a voice memo and send it to Stories at Arm and a leg show.com or call and leave us a message at 7 2 4.

2, 7, 6, 6, 5, 3 4. That is 7 2 4 arm n leg, or just go to www.armandalegshow.com/contact. You can upload a voice memo there too, or just start typing. Please keep it coming. We’ll be back with a new episode next week. Till then, like never before, take care of yourself.

This season of an arm and a leg is now more than ever supported by you as we move into weekly production for the duration, that is a bigger deal than ever before. Thank you to everybody who stepped up to help us out. We will be calling out names in a minute and you can join in. By going to armanda leg show.com/support.

First, this episode was produced by me, Dan Weissman and edited by Anne Heman. Daisy Rosario is our consulting managing producer, and Adam Raimundo is our audio wizard. Our music is by Dave Weiner and Blue dot sessions. This season of an Arm and a Leg is a co-production with Kaiser Health News. That’s a nonprofit news service about healthcare in America.

That’s an editorially independent program of the Kaiser Family Foundation. Kaiser Health News. Is not affiliated with Kaiser Permanente, the big healthcare provider. They share an ancestor. This guy Henry j Kaiser, he had his hands in a lot of different stuff like steel concrete shipbuilding. When he died more than 50 years ago, he left half his money to the foundation that later created Kaiser Health News.

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