- Michael Santos, 28, thought he had the coronavirus in February, so he went to the emergency room to find out.
- Santos never got a coronavirus test, but he did end up with a $1,689.21 bill. After Business Insider inquired about the bill, his insurer, Cigna, covered the cost.
- Congress and the Trump administration announced moves to protect patients from big bills when they seek coronavirus testing and care, but there are loopholes.
- Visit Business Insider's homepage for more stories.
Michael Santos said he'd never felt sicker in his life when he decided to go to the emergency department at Jefferson Methodist Hospital in Philadelphia.
Santos, 28, had severe back pains, weakness, and what he called a "raspy, phlegmy-sounding cough." He feared he had COVID-19, the disease caused by the coronavirus, when he started having difficulty breathing.
"It was probably the sickest I've ever been," Santos said of his illness in February. "I don't get sick very often. I've had the flu before but I don't remember it ever being this bad."
Weeks later, he would come to regret ever going to the hospital. The visit, on February 15, lasted no more than 45 minutes. He never got tested for coronavirus, and a few weeks later he received a $1,689.21 bill in the mail that he said he couldn't afford to pay.
A $1,418 charge for a flu test
When Santos called Jefferson to ask about his bill, he said the hospital told him it couldn't do anything but put him on a payment plan, and to call his insurer. Santos called Cigna and was told to appeal the bill by sending a form through the mail.
When Business Insider asked about the charges while reporting this story, Cigna paid the bill.
Santos' story shows how the US is falling short on its goal to cover the costs of testing and care for people who have the coronavirus, or think they have it. The US government says it's requiring insurance companies to cover testing and treatment for COVID-19 patients or "presumptive" patients, but it's not clear exactly what that means.
Because of the timeline of events, Santos didn't get the protections when he sought care in February. Other patients tested for the flu — or patients who can't get a coronavirus test — could face similar bills. It's possible for people to have both the coronavirus and the flu at the same time, studies show.
Cigna said its policy is to waive patient costs for COVID-19 treatment beginning Feb. 4 and for tests beginning March 3. For the policy to apply, providers need to use a billing code indicating that a person had the coronavirus or was exposed to it, Cigna said.
"During this time of heightened concern, Cigna's role is clear. We will do everything we can to help contain this virus, remove barriers to testing and treatment and give peace of mind to those we serve," David Cordani, Cigna's CEO, said in a statement to Business Insider. "This is another example of how, every day, we strive to stand by our customers through their life and health journeys."
A copy of the bills Santos got in the mail a few weeks after his visit shows Jefferson charged $1,310 for the emergency department visit and $1,418 for a flu test, which came back positive for influenza type B. The hospital also charged $410 for chest X-rays.
Cigna negotiated $1,712.23 off the bill but didn't make any payments toward it initially, leaving Santos to pay the remaining balance of $1,689.21. Santos said he would have gone to his primary care doctor, who also works at Jefferson, but the office wasn't open on weekends.
Santos got sick before the coronavirus lockdowns
Santos took the train from Philadelphia to Rhode Island and back in early February, the weekend before he got sick. The train had gone through New York, which would later become the epicenter for the coronavirus pandemic in the US.
Santos began having flu-like symptoms two days after returning to Philadelphia. On Thursday, Feb. 13, he called out sick from his job at Citizens Bank. He stayed in bed for two days and became worried when he developed a bad cough and had trouble breathing.
He was hesitant to go to the hospital because he worried he might get a medical bill even of a couple hundred dollars. He'd drained much of his savings when he moved from Rhode Island to Philadelphia in November.
But Santos had been reading about the coronavirus in the news and his symptoms seemed similar. When he talked to his mom on the phone she encouraged him to get checked out and even offered to pay his bill.
"I don't want her to pay it now that I see how expensive it is," Santos said in an interview last week. "I feel bad."
Policymakers tried to stop this from happening
High bills after an emergency room visit aren't unique to the coronavirus pandemic. A survey by the research institute NORC at the University of Chicago found that 57% of people report they've been surprised by a medical bill they had to pay that they thought would be covered by their health insurance.
But the coronavirus pandemic brought the issue back to the forefront as people lost their jobs and medical coverage. Congress passed two bills in March requiring insurers to pay for certain coronavirus treatments and tests without charging patients. Insurers are supposed to pay the tab even if a provider isn't in a patient's network.
On top of that, the Trump administration determined that hospitals who accept federal bailout money can't bill patients who have COVID-19 — or are presumed to have the disease — any amount greater than what the patient would have otherwise been required to pay if the care had been given by a provider in their network.
Jefferson didn't respond to inquiries about how much the hospital received in federal stimulus money or when it started to have coronavirus tests available.
Jefferson's hospital is in Santos' insurance network, and he received the $1,689.21 bill because he hadn't yet met his insurance plan's deductible, according to a document from Cigna.
"While we can't discuss this specific case due to federal privacy laws, deductibles are applied based on the insurance plans patients purchase either on their own or through their employers," said Jessica Lopez, Jefferson spokeswoman.
The federal laws and regulations leave room for someone like Santos to face a big bill, said Jack Hoadley, research professor emeritus in the Health Policy Institute of Georgetown University's McCourt School of Public Policy. While new protections were added, he said, they still come with gaps and loopholes.
Doctors sometimes order other tests to rule out other conditions, and while the regulations are supposed to extend to people who are "presumptive" COVID-19 patients, that can be hard to determine if they don't get a test.
"It's a very narrow set of protections specific to a patient who ends up with a coronavirus test ordered," Hoadley said.
Santos also sought care before Congress passed its legislation and before Cigna announced it would waive costs. Before Cigna handled the charges, he said he felt "punished" for trying to do the right thing.
"It was pretty well known at the time that this was a serious problem across the globe," he said.
A recent Gallup survey found that fear of high costs would prevent 9% of people who thought they had the coronavirus from seeking care.
When this happens, then people risk spreading the virus to others, Hoadley said.
"That's why we want to see these financial barriers eliminated, so people won't be afraid of going in," he said.
Business Insider is interested in your experience getting medical care during the coronavirus pandemic. If you are willing to share your story, please email senior healthcare reporter Kimberly Leonard at KLeonard@businessinsider.com.