Hospital Bills For Uninsured COVID-19 Patients Are Covered, But No One Tells Them

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Angela Settles’ husband Darius died of COVID-19, on July 4th. He was 30 years old, had no underlying conditions and was the youngest fatality in Nashville at that point.

Blake Farmer/WPLN News

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Blake Farmer/WPLN News

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Message never makes it to patients

TriStar, like most major health systems, participates in program through the Centers for Medicare and Medicaid Services in which uninsured patients with COVID-19 have their bills covered. It was set up through the pandemic relief legislation known as the CARES Act.

But TriStar doesn’t tell its patients that upfront. Neither do other hospitals or national health systems contacted by WPLN News. There’s no requirement to, which is one of the program’s shortcomings, says Jennifer Tolbert of the Kaiser Family Foundation who studies uninsured patients. (KHN is an editorially independent program of KFF.)

«This is obviously a great concern to most uninsured patients, Tolbert says. Her research finds that people without insurance often avoid care because of the bill or the threat of the bill, even though they might qualify for any number of programs if they asked enough questions.

Tolbert says the problem with the COVID-19 uninsured program is that even doctors don’t always know how it works or that the program exists.

«At the point when the patient shows up at the hospital or at another provider site, it’s at that point when those questions need to be answered, she says. «And it’s not always clear that that is happening.

Among clinicians, there’s a reluctance to raise the issue of cost in any way and run afoul of federal laws. Emergency rooms must at least stabilize everyone, regardless of their ability to pay, under a federal law known as EMTALA. Asking questions about insurance coverage is often referred to as a «wallet biopsy, and can result in fines for hospitals or even being temporarily banned from receiving Medicare payments.

Physicians also don’t want to make a guarantee, knowing a patient still could end up having to fight a bill.

«I don’t want to absolutely promise anything, says Dr. Ryan Stanton, an ER physician in Lexington, Ky., and a board member of the American College of Emergency Physicians.

«There should not be a false sense that it will be an absolute smooth path when we’re dealing with government services and complexities of the health care system, he says.

Could I have done more?

Darius Settles knew he was in bad shape. But he didn’t attempt to make a third trip to the hospital. Instead of 911, he called his father, pastor David Settles, and asked his father to come pray for him.

When the elder Settles replied that he was always praying for his son, Darius said, «No, I really need you to pray for me. I need you to get the oil, lay hands on me and pray, David Settles recalls, and so he went, despite concern for catching COVID-19 himself.

He sat by his son’s side. Darius’s wife made some peppermint tea, and when they put it to his lips, Darius didn’t sip. They thought he had fallen asleep. But he was unconscious.

At that point, they called 911 again and the operator instructed them to get Darius to the floor and perform chest compressions until paramedics arrived.

For 11 minutes, Angela pumped her husband’s chest, occasionally asking the dispatcher «what’s taking so long, the 911 recordings show. Even after help showed up, Darius never revived.

Pastor Settles was back in the pulpit just a few weeks later, preaching on suffering and grief after the death of his son, «whom I watched as the breath left his body, he told his congregation. «The Lord gives, and the Lord takes away.

Darius left behind his own son, who was 6. And his widow’s head is still spinning. She says she can’t shake a sense of personal guilt.

«Could I have done more? Angela Settles asks. «That’s hard, and I know that he would not want me to feel like that.

She wonders, too, if the hospital could have done more for Darius. And even after failing to disclose its policy for uninsured COVID-19 patients, it did send her a bill for part of her husband’s care. Asked why, a TriStar spokesperson says it was sent in error and does not have to be paid.

This story is from a reporting partnership that includes WPLN, NPR and KHN.