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Healthcare Consumer Navigator Center is a Healthcare Consumer Advocate Organization that helps consumer navigate the healthcare maze. The following Series “KEEPING THE CONSUMER SAFE; LIVING WITH COVID”.  Our goal is to provide a commonsense approach to living with covid with general healthcare information.

As previously documented in this space, I have had two doses of the Moderna vaccine. My second dose was in February 2021.

So the question I’ve now faced is whether or not to get a booster shot. I was infected with the COVID virus mid-September and had no symptoms (asymptomatic). I have spent hours on the internet searching for an answer to what I thought was a pretty simple, straight-forward question, “Should a 67-year old, vaccinated individual, recently recovered from COVID get a booster shot?”

Here’s what I’ve learned.

I’m now in a category called “breakthrough cases.” According to the CDC website, “COVID-19 Vaccine Breakthrough Case Investigation and Reporting,” a vaccine breakthrough infection is defined as the detection of SARS-Cov-2 or antigen in a respiratory specimen collected from a person > 14 days after they have completed all recommended doses of a U.S. Food and Drug Administration authorized COVID-19 vaccine.

According to the website as of October 18, 2021, 41,127 patients with COVID-19 vaccine breakthrough infection were hospitalized or died. Thankfully, I don’t fall into either of those categories. The breakdown was 10,857 deaths and 30,270 hospitalizations. I wonder how large the overall number might be? The website goes on to explain the data is incomplete and this is only a snapshot of the breakthrough cases. To date, no unexpected patterns have been identified.

In a single sentence, I seemingly found what I was looking for…”Currently, CDC is recommending that moderately to severely immunocompromised people receive an additional dose of mRNA COVID-19 vaccine at least 28 days after a second dose of Pfizer-BioNTech COVID-19 vaccine or Moderna COVID-19 vaccine. I continued to search for a specific reference to someone having COVID and a specific recommendation for this condition because of all the “immunity” discussions that exist on the web. I didn’t find any.

As a last resort, I contacted a physician and she recommended getting the booster.

Frankly, this doesn’t feel all that scientific to me. The more I researched the more I learned there is a great deal of studying and data gathering ongoing that haven’t yet produced what one would consider “scientific” results.

According to the CDC, “more than 189 million people in the US have been fully vaccinated as of October 18, 2021.” The approximately 11 thousand reported breakthrough deaths translates to .0058%. So in my unofficial, unscientific capacity the vaccine seems to be working.

My own personal experience demonstrates the vaccine greatly mitigated my bout with COVID.

I can attest researching COVID can be a very frustrating and time consuming endeavor. While one will find many references to “following the science.” In reality, for mere mortals understanding the science can be daunting.

Here’s my unsolicited advice from my own experiences.

-Be attentive about potential COVID symptoms in yourself and others. Vaccinated people can become infected and be asymptomatic or have very mild symptoms. They

are contagious. It’s how I became infected.

-Consult your physician about getting a booster shot if you fall in the CDC recommended eligibility group.

-If you are immunocompromised, get a pulse oximeter to monitor your oxygen levels.

If your number drops below 93%, see a physician. Do not wait! My partner went from

92% to 76% in a day!

-Find a website you trust, presents in understandable language and stays up to date so you can routinely follow to stay current on COVID. The more you know the better off you’ll be. This is very much an evolving subject.

-People are still dying from COVID that shouldn’t so don’t let your guard down!

KEEPING THE CONSUMER SAFE; LIVING WITH COVID Segment 4: Covid Story Part 2; The Alaska Story

Healthcare Consumer Navigator Center is a Healthcare Consumer Advocate Organization that helps consumer navigate the healthcare maze. The following Series “KEEPING THE CONSUMER SAFE; LIVING WITH COVID”.  Our goal is to provide a commonsense approach to living with covid with general healthcare information.

I must admit hearing I was positive and over 200 miles from the nearest healthcare facility by air gave me pause.

Just to be certain my test wasn’t a false positive, I was tested a second time the next day and was positive again. So let the confusion begin…

Per the CDC:

“People who have been in close contact with someone who has COVID-19 are

not required to quarantine if they have been fully vaccinated against the disease

and show no symptoms.”

Check and check.

Quarantine vs. Isolation?

The positive test changed everything. I was now required to quarantine despite not showing any symptoms. Interestingly, the CDC guidelines now reference “watching for fever (100.4 F).” So now temperature was reintroduced to the diagnosis formula (I had no fever at the time of the positive test or during the entire time of quarantine.)

Now being quarantined with literally nothing to do but read or sleep. I became curious as to what the “treatments” for COVID were short of being admitted to a hospital. Back to the internet.

Off to 363 pages of medical jargon. Thanks, but no thanks. Off to the Mayo Clinic’s website. Much better-“Treating COVID-19 at home: Care tips for you and others.”

“If you have coronavirus disease 2019 (COVID-19) and you’re caring for yourself at

at home…you might have questions. Duh! How do you know when emergency care

is needed? How long is isolation necessary? What can you do to prevent the spread

of germs?”

Most people who become sick with COVID-19 will only experience mild illness and

            can recover at home. Symptoms might last a few days, and people who have the virus             might feel better in about a week. Treatment is aimed at relieving symptoms and

            includes rest, fluid intake and pain relievers.” Emphasis provide by me and after reading

            I’m sure I had a sigh of relief…but wait what’s all the national hysteria been about? I                       don’t recall once hearing any news media person utter the first two sentences of the

            above paragraph. But wait…there’s more…

            The next paragraph starts…” However, older adults (that’s me) and people of any

            age with existing medical conditions (also me) should call their doctor as soon as                        symptoms start” (see part 1 for symptoms).

Ok, everybody with me? I’m elderly (over 65), have a pre-existing condition, 3,200 miles         from my physician and my best guess at this point is I’ve been positive for probably 5 to 6 days but don’t know for sure since I’ve been symptom free.

So, I’m reading on and they’ve got my full attention…the final section is titled “Emergency warning signs.”  Carefully monitor yourself for worsening symptoms. If symptoms appear to be getting worse, call the doctor. I wonder what medical scholar wrote that sentence. In my world, we might call that a blinding glimpse of the obvious.

“The doctor might recommend use of a home pulse oximeter, especially if the ill person has risk factors for severe illness with COVID-19 and COVID-19 symptoms.”


That’s all for now, stay tuned for more to come.


Covid Story 1 Part 1; The Alaska Story

Healthcare Consumer Navigator Center is a Healthcare Consumer Advocate Organization that helps consumer navigate the healthcare maze. The following Series “KEEPING THE CONSUMER SAFE; LIVING WITH COVID”.  Our goal is to provide a commonsense approach to living with covid with general healthcare information.

On September 14, 2021, I tested positive for Covid. Unfortunately, I was at a fishing lodge in remote Alaska. I decided this would provide an excellent opportunity to share a real-life Covid experience.

As background information, I received my first Moderna vaccination shot on January 27, 2021. I received by second shot on February 24, 2021. In accordance with the lodge’s Covid protocol, I tested negative for Covid on September 3, 2021. This was 72 hours prior to my arrival at the lodge.

Because of the limited number of people, I had contact with that ultimately tested positive for Covid, tracing the source was reasonably simple. Based upon this contact tracing, I was exposed to a contagious person on either September 8 or 9. I had no Covid symptoms from my initial contact through my quarantine period that ended on September 24. Notably, my wife accompanied me on this trip tested negative for Covid 3 times post my positive test.

Approximately 30 people were within proximity of the original contagious person. To the best of my knowledge 6 people tested positive from either primary or secondary contact with the original person. From September 8 until my positive test on September 14 and subsequent immediate quarantine, no one contracted the virus from contact with me validated by two separate testings of everyone at the lodge spaced 7 days a part.

The above facts represent to the best of my memory the circumstances surrounding my positive Covid test. Hereafter are personal observations and thoughts.

There is a great deal of unproven, unscientific information surrounding Covid. On the other hand, there is very limited information as to what a person with Covid might like to know.  Let me start with something basic like what should one do upon learning they are Covid positive with limited access to medical personnel. Of course, go to the internet!

Let’s start with the CDC. First, symptoms-

            -Fever or chills


            -Shortness of breath or difficulty breathing


            -Muscle or body aches


            -New loss of taste or smell

            -Sore throat

            -Congestion or runny nose

            -Nausea or vomiting


Now to be perfectly honest, I have routinely experienced about a third of these symptoms on many of my previous Alaska fishing trips-fatigue, muscle or body aches, sore throat, congestion, or runny nose. It’s part of being in Alaska in September. So, after narrowing down the symptoms list, I decided I was asymptomatic. Keep in mind my wife and I were living in a 20’ x 20’ cabin up until my quarantine.

What seemingly has changed from the beginning of Covid until now. A year ago, at this same lodge our temperature was taken every morning at breakfast. I now see temperature must no longer be a symptom associated with Covid. Something I’ve learned from others with Covid, however, is oxygen level is a very important traceable symptom and using a pulse oximeter can be any easy way to monitor. Declining oxygen levels are a very good warning sign.

Stay tuned I’ll continue my journey in future blogs.

8 Things to Know When Choosing a Medicare Plan

By Neal Templin Oct. 17, 2021 9:00 am ET Wall Street Journal

The choices can be confusing, and the fine print is important. But it’s crucial to choose wisely, because it may be hard to change your mind.

When most Americans turn 65, they have three basic options for health coverage: traditional Medicare; Medicare plus supplemental insurance to cover costs that Medicare doesn’t; or Medicare Advantage, a range of managed-care plans.

Making the decision isn’t easy. There’s a lot of fine print when it comes to expenses and coverage. But choosing the wrong plan for your individual circumstances can be a costly mistake—and one that may be hard to undo, depending on where you live. Most states make it difficult to switch plans, so it’s often crucial to pick wisely.

With that in mind, here are eight things that every person should know when selecting the Medicare plan that makes the most sense for them. Keep these in mind, and you’re less likely to make a choice that you’ll later regret.  

1. Supplemental insurance is usually the best option for people who can afford it or who have health issues.

Ken Schumm of Olympia, Wash., who turns 65 later this year, had planned on buying a Medicare Advantage plan. It seemed the sensible and most-affordable option. Still, he wanted to be sure, since he has rheumatoid arthritis and takes expensive drugs to combat it.


To help him decide which coverage to choose, Mr. Schumm hired Medicare consultant Melinda Caughill, co-founder of 65 Inc., who calculated that with traditional Medicare with supplemental medical and drug insurance, he would face a total of $11,324 a year for premiums and his deductible. By contrast, if he chose an Advantage plan, the consultant calculated, his costs—including out-of-pocket spending for medical care and drug purchases—could run as high as $18,325 a year. Mr. Schumm’s medical costs are high in part because his out-of-pocket prescription costs will top $6,000 annually with either an Advantage plan or with traditional Medicare plus a drug supplemental plan, 65 Inc. calculated.

Advantage plans are financially risky for patients with health issues, Ms. Caughill says. With an Advantage plan, “Ken could potentially save $3,000 if he had no health needs,” she says. “But his worst-case scenario is thousands of dollars worse.” Based on his current health needs, she calculates that his annual costs with an Advantage plan would range from $8,325, if he uses only his drugs and doesn’t require doctor visits, to $18,325 if he uses doctors a lot and hits his plan’s spending caps.

By choosing Medicare and supplemental insurance, Mr. Schumm also will be able to go to any doctor or hospital that accepts Medicare without referrals. The most popular Medicare supplemental plans, such as the F or G plans, have no copays, though the G plan does have a $203 annual deductible.

In fact, people who are affluent are almost always better off with a Medicare supplemental plan, says David Armes, a California Medicare consultant. That is because, as noted later, eventually most people will have significant medical needs. Supplemental plans, while more expensive upfront, offers better coverage than the alternatives.

2. Having Medicare alone is risky.

Some 5.6 million Americans enroll in traditional Medicare but don’t buy supplemental insurance, according to the Kaiser Family Foundation. They all pay a monthly Medicare premium—people buying supplemental coverage or enrolling in Medicare Advantage must also pay this premium—but face no other costs except for drugs, if they don’t seek medical care.

The problem is if they get sick or injured and require a long-term stay in a hospital or skilled nursing facility. In that case, they are less protected from costs than patients who have supplemental coverage or who are in Medicare Advantage. Suppose you are in a bad car accident, and have to spend months in a skilled nursing facility. Medicare covers all of the costs for the first 20 days. For the next 80 days, you have a copay of $185.50 a day.

“It is like not getting home insurance,” says Mary Jeanne Cullen, a Medicare consultant in New Jersey. “There is financial risk.”

3. Medicare Advantage plans are cheaper for seniors in good health.

If you’re not going to the doctor a lot and usually stay in-network, Medicare Advantage is a less-expensive option than Medicare with a supplement. Not only do many Advantage plans have no monthly premiums, but they often include a drug plan and extra benefits like dental, vision or hearing care not covered by Medicare. Some offer gym memberships.

The catch, and it’s a big one: Medicare Advantage patients must use in-network providers or face copays that are substantially higher than what people with Medicare supplemental insurance customarily pay. So if you need to go to the top cancer hospital, and it isn’t in your plan, you might incur thousands of dollars in additional costs.

One other important point: You can’t just consider your current health in the decision. Starting in an Advantage plan, and figuring you can switch to a supplemental plan down the road if your health worsens could be a risky strategy, depending on where you live. In most states, the companies that sell supplemental insurance have the right to charge you more or deny you coverage altogether after that initial sign-up period.

4. Not all Advantage plans are created equal.

Some Advantage plans are set up as health-maintenance organizations, where you must stay within network to get coverage; others are set up as preferred provider organizations, which generally will pay a portion of costs when you go out of network. PPOs give patients a lot more freedom than HMOs, health experts say.

Stephen O’Brien, an insurance agent in Maine, says most of his clients can’t afford the $200-plus monthly premiums charged by popular Medicare supplemental insurance plans. He steers his clients to a no-premium PPO with annual out-of-pocket maximums of $5,900 for in-network care and $10,000 for both in- and out-of-network care. It allows patients to go to top hospitals and doctors in Boston, many of which are in network.

“If something really happens,” Mr. O’Brien says, “you want to go where you need to go.”

5. Supplemental plans are the better option for people who travel.

Medicare Advantage plans usually have a network of doctors in a certain state or portion of a state. If you’re traveling, they generally will cover treatment for medical emergencies, but not for routine or chronic problems.

There are exceptions. Some Advantage plans do have national networks in which you have access to certain hospitals and doctors outside your service plan.

Supplemental coverage, by contrast, can be used with any doctor or hospital that accepts Medicare in the U.S.

6. Supplemental plans usually get more expensive as you get older.

Most supplemental plans use attained-age pricing, meaning the premium automatically goes up for each year you hold it. The plans often have additional increases to cover rising medical costs.

7. It can be difficult switching to Medicare with supplemental insurance.

During the first six months after you enroll in Medicare Part B, which covers doctors and other outpatient services, you are guaranteed the right to buy supplemental insurance. You won’t have to answer health questions from the insurance company selling it, and you can’t be rejected for pre-existing conditions. If you try to buy supplemental insurance after that six months runs out, however, the insurer can charge more because of health issues or deny coverage altogether. A supplemental plan at that point might be impossible or unaffordable.

It is a slightly different story for patients in Advantage plans. In most states, whether you started out in an Advantage plan or switched to one later, you have 12 months from when the plan began to switch instead to Medicare and buy supplemental insurance without having to answer questions from an insurer, says Ms. Caughill of 65 Inc. Any point during that time, she adds, “you can change to original Medicare plus a supplement.”

Some states have even more liberal policies for switching. A few—including New York, Connecticut, Massachusetts and to a degree, Maine—use a health-insurance system known as community ratings, which legally requires insurers to offer all consumers in that state the same rate regardless of age or health. In those states, people can move from an Advantage plan to traditional Medicare plus supplemental coverage after their initial enrollment period, without having to answer health questions from the insurance company selling it, and you can’t be rejected for pre-existing conditions.

8. Don’t forget the “nuclear option.”

For people who don’t live in one of these states and are in desperate need of affordable health coverage, Ms. Caughill of 65 Inc. will sometimes recommend what she calls the “nuclear option.” Such patients can get a redo by moving outside their Advantage plan’s service area. Any time you move out of an Advantage plan’s service area, which could be a county, several counties, or an entire state, you have the right to get supplemental insurance in the new service area as if you were just entering the market. The insurer can adjust the price based on age, gender or smoking status, but it can’t charge more because of existing conditions.

“You get a Medicare enrollment do-over,” she says.

Ms. Caughill had one client with lung cancer who moved from Wisconsin to Colorado to get into a supplemental plan. But she cautions people they must actually move. “Otherwise,” she says, “you’re committing insurance fraud.” 

Mr. Templin is a former Wall Street Journal reporter and editor. He can be reached at [email protected].


Covid Stories and General Information

Healthcare Consumer Navigator Center is a Healthcare Consumer Advocate Organization that helps consumer navigate the healthcare maze. The following Series “KEEPING THE CONSUMER SAFE; LIVING WITH COVID”.  Our goal is to provide a commonsense approach to living with covid with general healthcare information.

The idea of COVID can become very easy to ignore if you are amongst the lucky to escape being touched by the virus. We believe somewhere along the COVID journey the country entered what we refer to as COVID Fatigue.  Covid fatigue has been caused by massive amounts of social media coverage, the politicization of the virus, the deadly nature of the virus and the widespread impact the virus has had upon the American way of life. Debates have emerged over getting or not getting the vaccine. Conflicts have developed over whether school children should wear masks or not. According to polls, how people actually think about the virus depends upon their political party affiliation.  Understanding the virus as a medical condition by the general citizenry has become very challenging. Very few Americans have ever been exposed to the challenges a pandemic poses. We aren’t accustomed to the killing force an unknown virus can cause and understand the apparent limited medical intervention has on preventing death.

The  following two stories are vastly different experiences with COVID. The timing is very different as one occurs prior to vaccine access and the other post vaccination. One perspective is from a positive test and ultimate admission to the ICU of a hospital and a near death experience. The other perspective is from a positive test and asymptomatic experience. Both experiences have proven to be very impactful on understanding the many different dimensions the virus exposes.

For example, imagine being unknowingly exposed to the virus, unknowingly having the virus for approximately 6 days, being randomly tested and learning you’re positive?

On the other hand, imagine being tested and learning your positive. Contact your primary care physician via tele-health and being prescribed “Ivermectin.” Contact primary care physician two days later while experiencing no real improvement. Two days more and again contact primary care physician without any improvement. 3 more days head to hospital ER and immediately sent to COVID isolation unit. Oxygen level in the 70% range.

We are sharing our stories because we think with this knowledge peoples’ lives can be saved. We’re also sharing these stories to help eliminate some of the myths that seem to be rampant in social media. We also believe the public needs to know that not everyone in the medical community is up to speed on the diagnosis and treatment of COVID. GETTING TO THE RIGHT MEDICAL PROFESSIONAL AND THE RIGHT MEDICAL INSTITUTION COULD BE THE DIFFERENCE BETWEEN LIFE AND DEATH!

How to Crush Medical Debt: 5 Tips for Using Hospital Charity Care

By KHN Emily Pisacreta OCTOBER 15, 2021

What if a law passed but no one enforced it? That’s essentially what has happened with one small but helpful rule about hospitals and financial assistance for medical bills.

The Affordable Care Act, the health law also known as Obamacare, requires nonprofit hospitals to make financial assistance available to low-income patients and post those policies online. Across the U.S., more than half of hospitals are nonprofit — and in some states all or nearly all hospitals are nonprofit. But many people who qualify for financial assistance — or “charity care,” as it is sometimes known — never apply.

Jared Walker is helping get the word out. He founded Dollar For, an organization that directly helps people use hospital financial assistance policies to overcome unaffordable medical bills. Walker earned the public’s attention early this year through a viral TikTok he made on a lark, late one night.

In the 60-second video, Walker outlines the basics of applying for hospital financial assistance, in response to a prompt that asks TikTokers to share “something you’ve learned that feels illegal to know.”

“Most hospitals in America are nonprofits, which means they have to have financial assistance or charity care policies,” he says in the video. “This is going to sound weird, but what that means is if you make under a certain amount of money the hospital legally has to forgive your medical bills.”

The video outlines the basics of applying for hospital charity care, which he says he uses to “crush” medical bills.

An Arm and a Leg,” a podcast about the cost of health care, has been covering Walker and his organization’s work since the video’s viral moment, as well as the decades-long fight to establish charity care rules that preceded it.

Here are five strategies Walker endorses and shares during monthly volunteer training sessions:

1. How do you find the policy?

Walker’s trick for finding a hospital’s financial assistance policy is as straightforward as it gets: Google it. Enter the hospital’s name, followed by “financial assistance policy” or “charity care policy.” The first search results are likely to be an outline of the policy and an application to submit.

Your first instinct might be to go to your hospital’s home page. But that’s likely a mistake. Policies tend to be hidden from hospital website menus, according to Walker. In many states, charity care laws are more specific than what’s outlined in the ACA, and hospitals may be required to display their financial assistance policies prominently.

It’s rare for the policies not to be available online at all, but in some cases, Walker said, you may need to call the hospital and ask for an application.

2. Who qualifies?

Most hospital charity care policies are income-based, using percentages of the federal poverty guidelines to define eligibility. In an example, Walker showed the guidelines for St. Luke’s Hospital of Kansas City, where patients earning 200% of the federal poverty guidelines were responsible for 0% of their bill. That figure was just over $2,000 a month in 2021. Those making 201% to 300% were eligible for certain discounts.

Not sure how your income compares to the federal poverty guidelines? Here’s one of many helpful online calculators. Remember, your household is you, plus your spouse, plus anyone you claim as a dependent on your taxes. Roommates don’t count.

Applications typically require documentation to prove your income. Hospitals ask for things like recent pay stubs, proof of unemployment, Social Security award letters and tax returns, according to Walker. Exactly which documents the hospital may ask for can vary. But a hospital can’t deny you for failing to provide a document that isn’t spelled out in the application.

3. In collections? You may still have time.

The IRS requires nonprofit hospitals to give patients a grace period of 240 days (about eight months) from the initial billing date to apply for financial assistance. But hospitals are allowed to send bills to collection agencies much earlier than that — often after just 120 days.

At that point, patients often feel as though they’re being hounded by notifications from collection agencies. Still, patients may have months remaining to apply for financial assistance, and alerting the collection agents that an application with the hospital is in process can sometimes stop the letters.

“The hospital can take you out of collections just as easily as they put you there,” Walker said.

In some cases, hospitals will forgive bills that are much older than 240 days. When in doubt, applying may be worth it even for bills that are several years old, Walker said. It does not hurt to ask for help.

4. Looks like you won’t qualify? Write a letter.

If you don’t qualify on income alone but you still can’t afford your hospital bills, don’t rule yourself out. The same applies if the hospital’s financial aid policy specifies that only uninsured people qualify; you might have insurance but are still looking at giant bills you can’t pay.

Walker said a letter of financial hardship attached to an application can help. In fact, he encourages each patient to attach a letter, no matter how strong their application seems.

“These are real people reading these and the letters go a long way,” he said. Ultimately, each hospital is making a judgment call about who gets the assistance it is legally obligated to provide. Make your case.

5. Yes, you may need to fax it in.

While many hospitals have digital portals to enable online bill-paying, there’s usually no equivalent for applying for financial assistance. Many applications offer only a mailing address. But Walker and his team have found that applications sent by mail frequently get lost.

Instead, they recommend either walking the application into the hospital and delivering it by hand or faxing it. Public libraries, packaging stores like FedEx and certain online services make faxing possible even if, like most people, you haven’t used a fax machine since the late 1990s.

When it comes to accessing charity care, “you’re gonna have to jump through a lot of hoops,” Walker said, “but it’s worth it.”

Emily Pisacreta is a reporter and producer with “An Arm and a Leg,” a podcast about the cost of health care that is co-produced with KHN. COPY HTML



Healthcare Consumer Navigator Center is a Healthcare Consumer Advocate Organization that helps consumer navigate the healthcare maze. The following Series “KEEPING THE CONSUMER SAFE; LIVING WITH COVID”.  Our goalis to provide a commonsense approach to living with covid with general healthcare information.

While this may seem to be a rather stupid question, we have two very different scenarios that we’d like to share. First, one scenario was early in the COVID journey, pre-vaccine and the medical community was still on a steep learning curve. The person tested positive but then based upon their personal physician advice waited 5 days and significant health deterioration  before going to the Emergency Room.

The second scenario is post vaccination and later in the COVID journey. The person was a symptomatic and only knew they had COVID because of being part of a “group” being tested. In all likelihood from some contact tracing, he’d been infected 5 or 6 days earlier.  The person infected had been vaccinated and the person infecting him had also been vaccinated.

As we reviewed the CDC’s COVID symptom’s list, we realized in today’s “vaccinated” environment, other conditions might resemble muted COVID symptoms. This requires a heightened awareness about personal health. If a person has underlying medical issues, waiting for the onset of full blown COVID symptoms, the timing might prove critical to the person’s health.

The average cost of a hospital COVID-19 test in each state

Alia Paavola – Wednesday, December 9th, 2020  Becker’s Healthcare

The cost of getting a standard COVID-19 test at hospitals varies drastically by state, according to a nationwide study conducted by Hospital Pricing Specialists

For the analysis, Hospital Pricing Specialists reviewed billing data from 2,862 hospitals across the U.S. to determine the average price of a nasal swab COVID-19 test. The claims reviewed had the Current Procedural Terminology code 87635.

The state with the highest average cost is New Jersey at a price of $302, whereas the lowest cost is in Maryland at $62.

Here is the average charge for a hospital nasal swab COVID-19 test in the 50 states and Washington, D.C.:

Alabama — $190

Alaska — $201

Arizona — $141

Arkansas — $240

California — $143

Colorado — $146

Connecticut — $137

Delaware — $115

District of Columbia — $249

Florida — $129

Georgia — $198

Hawaii — $226

Idaho — $125

Illinois — $188

Indiana — $176

Iowa — $143

Kansas — $147

Kentucky — $142

Louisiana — $174

Maine — $215

Maryland — $62

Massachusetts — $169

Michigan — $134

Minnesota — $175

Mississippi — $158

Missouri — $161

Montana  — $122

Nebraska — $173

Nevada — $111

New Hampshire — $190

New Jersey — $302

New Mexico — $172

New York — $175

North Carolina — $140

North Dakota — $141

Ohio — $161

Oklahoma — $174

Oregon — $141

Pennsylvania — $166

Rhode Island — $91

South Carolina — $113

South Dakota —$161

Tennessee — $140

Texas — $167

Utah — $149

Vermont —  $169

Virginia — $122

Washington — $185

West Virginia — $161

Wisconsin — $151

Wyoming — $149

A Covid Test Costing More Than a Tesla? It Happened in Texas.

By Aneri PattaniSEPTEMBER 30, 2021 Kaiser Health News

When covid-19 struck last year, Travis Warner’s company became busier than ever. He installs internet and video systems, and with people suddenly working from home, service calls surged.

He and his employees took precautions like wearing masks and physically distancing, but visiting clients’ homes daily meant a high risk of covid exposure.

“It was just like dodging bullets every week,” Warner said.

In June 2020, an employee tested positive. That sent Warner and his wife on their own hunt for a test.

Because of limited testing availability at the time, they drove 30 minutes from their home in Dallas to a free-standing emergency room in Lewisville, Texas. They received PCR diagnostic tests and rapid antigen tests.

When all their results came back negative, it was a huge relief, Warner said. He eagerly got back to work.

Then the bill came.

The Patient: Travis Warner, 36, is self-employed and bought coverage from Molina Healthcare off the insurance marketplace.

Medical Service: Two covid tests: a diagnostic PCR test, which typically takes a few days to process and is quite accurate, and a rapid antigen test, which is less accurate but produces results in minutes.

Total Bill: $56,384, including $54,000 for the PCR test and the balance for the antigen test and an ER facility fee. Molina’s negotiated rate for both tests and the facility fee totaled $16,915.20, which the insurer paid in full.

Service Provider: SignatureCare Emergency Center in Lewisville, one of more than a dozen free-standing ERs the company owns across Texas.

What Gives: Throughout the pandemic, stories of shockingly high prices for covid tests have abounded. A recent report from an insurance trade association noted that “price gouging by certain providers continues to be a widespread problem.”

But Warner’s PCR bill of $54,000 is nearly eight times the most notable charge previously reported, at $7,000 — and his insurer paid more than double that highest reported charge. Health policy experts KHN interviewed called Warner’s bill “astronomical” and “one of the most egregious” they’d seen.

Yet it’s perfectly legal. For covid tests — like much else in American health care — there is no cap to what providers can charge, said Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy.

Covid testing has been in a special category, however. When the pandemic hit, lawmakers worried people might avoid necessary testing for fear of the cost. So they passed bills that required insurers to pay for covid tests without copays or cost sharing for the patient.

For in-network providers, insurers can negotiate prices for the tests, and for out-of-network providers, they’re generally required to pay whatever price the providers list publicly on their websites. The free-standing ER was out of network for Warner’s plan.

While the policy was intended to help patients, health experts say, it has unintentionally given providers leeway to charge arbitrary, sometimes absurd prices, knowing that insurers are required to pay and that patients, who won’t be billed, are unlikely to complain.

“People are going to charge what they think they can get away with,” said Niall Brennan, president and CEO of the Health Care Cost Institute, a nonprofit that studies health care prices. “Even a perfectly well-intentioned provision like this can be hijacked by certain unscrupulous providers for nefarious purposes.”

report from KFF published earlier this year found that hospital charges for covid tests ranged from $20 to $1,419, not including physician or facility fees, which can often be higher than the cost of the tests themselves. About half the test charges were below $200, the report noted, but 1 in 5 were over $300.

“We observed a broad range of COVID-19 testing prices, even within the same hospital system,” the authors wrote.

Realistically, the cost of a covid test should be in the double digits, Brennan said. “Low triple digits if we’re being generous.”

Medicare pays $100 for a test, and at-home tests are sold for as little as $24 for an antigen test or $119 for a PCR test.

Warner’s charges were fully covered by his insurance.

But insurance policy premiums reflect how much is paid to providers. “If the insurance company is paying astronomical sums of money for your care, that means in turn that you are going to be paying higher premiums,” Adler said.

Taxpayers, who subsidize marketplace insurance plans, also face a greater burden when premiums increase. Even those with employer-sponsored health coverage feel the pain. Research shows that each increase of $1 in an employer’s health costs is associated with a 52-cent cut to an employee’s overall compensation.

Even before the pandemic, wide variability in the prices for common procedures like cesarean sections and blood tests had been driving up the cost of health care, Brennan said. These discrepancies “happen every single day, millions of times a day.”

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Resolution: When Warner saw that his insurance company had paid the bill, he first thought: “At least I’m not liable for anything.”

But the absurdity of the $54,000 charge gnawed at him. His wife, who’d received the same tests the same day at the same place, was billed $2,000. She has a separate insurance policy, which settled the claim for less than $1,000.

Warner called his insurer to see if someone could explain the charge. After a game of phone tag with the ER and the ER’s billing firm, and several months of waiting, Warner received another letter from his insurer. It said they’d audited the claim and taken back the money they had paid the ER.

In a statement to KHN, a spokesperson for Molina Healthcare wrote, “This matter was a provider billing error which Molina identified and corrected.”

SignatureCare Emergency Centers, which issued the $54,000 charge, said it would not comment on a specific patient’s bill. However, in a statement, it said its billing error rate is less than 2% and that it has a “robust audit process” to flag errors. At the height of the pandemic, SignatureCare ERs faced “unprecedented demands” and processed thousands of records a day, the company said.

SignatureCare’s website now lists the charge for covid tests as $175.

The Takeaway: Covid testing should be free to consumers during the public health emergency (currently extended through mid-October, and likely to be renewed for an additional 90 days). Warner did his insurer a big favor by looking carefully at his bill, even though he didn’t owe anything.

Insurers are supposed to have systems that flag billing errors and prevent overpayment. This includes authorization requirements before services are rendered and audits after claims are filed.

But “there’s a question of how well they work,” Adler said. “In this case, it’s lucky [Warner] noticed.”

At least one estimate says 3% to 10% of health care spending in the U.S. is lost to overpayment, including cases of fraud, waste and abuse.

Unfortunately, that means the onus is often on the patient.

You should always read your bill carefully, experts say. If the cost seems inappropriate, call your insurer and ask them to double-check and explain it to you.

It’s not your job, experts agree, but in the long run, fewer overpayments will save money for you and others in the American health care system

Report: Only 5% of hospitals fully compliant with controversial price transparency rule

by Robert King | Jul 19, 2021 11:24am FIERCRE HELTHCARE

A new analysis found only 5.6% of hospitals were fully compliant with a major price transparency rule, with most failures centered on not posting payer-negotiated prices.

The analysis released Friday by the group is the latest evidence of widespread noncompliance with the rule, which went into effect back in January. 

“These findings align with previous research indicating that hospitals are undermining the rule with incomplete information, burdensome access restrictions, code to block prices from being displayed on search engines and tools to obfuscate access to mobile app developers and to patients,” the analysis said.

Another problem has been price estimator tools that don’t enable meaningful accessible comparison of discounted cash prices, researchers said.

The group examined a random sample of 500 hospital websites out of the roughly 6,000 facilities subjected to the rule’s requirements.

Only 5.6% of the websites were compliant with all the rule’s requirements. It found that 471 facilities did not post a complete machine-readable file of standard charges.

RELATED: Only 1 in 10 patients know hospitals are now required to post their prices online, survey finds

A large majority (80.6%) of hospitals did not publish payer-specific negotiated charges that were clearly associated with each payer and plan, a controversial requirement of the rule. It found that 258 hospitals (51.6%) didn’t publish any negotiated rates at all and 198 hospitals (39.6%) didn’t publish any discounted cash prices.

The rule required hospitals to also publish 300 shoppable healthcare services in a list or an estimator tool. The group found that 96 hospitals presented them in a “consumer-friendly display for customary charges. However, a significant number of these hospitals presented incomplete data fields and were therefore noncompliant.

There were 378 hospitals that posted a price estimator tool. However, the tools were inconsistent and limited researchers’ ability to determine if the tool was compliant with the rule.

The analysis is the latest finding that many hospitals are not complying with the new rule. A study published last month found that 83 out of 100 randomly sampled hospitals were not compliant with the regulation.

The Centers for Medicare & Medicaid Services has sent out warnings to some hospitals for noncompliance. There is a $300-per-day penalty for hospitals for each day they aren’t fully following the regulation.

But the analysis posits that the penalty is nowhere near enough.

“Scaling the penalty to $300 per hospital per bed per day and robustly enforcing the rule will result in a meaningful financial incentive for hospitals to comply, while providing proportional fairness to smaller and rural hospitals,” the group said. also wants CMS to scrap the requirement for a price estimator tool and instead require hospitals to provide “guaranteed price quotes.”

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