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Cost of Care: Explaining COVID-19 medical billing in Colorado

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Posted at 4:51 PM, Jun 04, 2020
and last updated 2020-06-05 08:35:45-04

DENVER — As the Colorado COVID-19 curve flattens and more patients are released from the hospital after beating the virus, the next step for many becomes paying for their treatment. Denver7 is here to help, with this COVID-19 Cost of Care explainer.

The first document likely to arrive to COVID-19 patients is an explanation of benefits, or EOB. This is an explanation of every form of treatment, every procedure performed, every medication or lab test needed, basically everything that costs money from a healthcare provider listed in a single document. They are from your insurance company, and include “this is not a bill” somewhere on it.

Robert Dennis saw charges totaling more than $840,000. Ernesto Castro read the number $139,254. Both beat COVID-19. Both were shocked to see the total “charges” on their EOBs.

“That’s a lot like the sticker price when you go to buy a new car. It’s the gross charge and it’s also a charge that few, if any, people actually ever pay,” Julie Lonborg of the Colorado Hospital Association explained.

The EOB must be sent out to patients by law, and include the set price that all patients are charged for services, for example, at a hospital. Insurance companies then have negotiated rates with those providers, and in the case of COVID-19, many charges are being covered completely.

But if an EOB isn’t a bill, what about the actual bill from the hospital? Lonborg says those are likely not en route to patients.

“Many hospitals right now are processing the insurance portion of this process and receiving payment from insurance companies but are holding the patient’s bill,” she said.

Since the rules and regulations from the state and federal level continue to change, as does the coding done by insurance companies, hospitals want to make sure the bills they do send out are accurate and current. So many are waiting to send them and many may not receive a bill at all.

“Many patients through all of this won’t end up owing much of anything,” she said.

Because of federal and state COVID-19 funding for testing and treatment, and with the fact that many insurance companies are not making their customers take part in any cost sharing for treatment, many patients could end up paying nothing. The final amount a patient may owe will come from their insurance company and their individual insurance plan.

So what should patients who beat the virus do?

“Patients (should) call their insurance company to understand what their individual plan and individual insurance company decided to do and for further peace of mind, to call the hospital and just say, 'can you help me understand how you’re processing things right now?” Lonborg said.

Both the insurance company and the hospital can clarify exactly where a patient stands in terms of billing and what to expect in the future.

If you’ve received treatment for non-COVID medical needs, then the regular medical billing process will take place.

Medical billing is an extremely complicated subject with ever-changing policies and intricacies. If you have individual specific questions about your bill, call your insurance company or healthcare provider.