Vaccines are free, but getting coronavirus can cost residents thousands

May 24—Getting the coronavirus vaccine is free. What's not free? Getting coronavirus.

The average personal cost to a patient hospitalized with coronavirus at a ProMedica hospital is between $900 and $1,500, and that's with insurance companies waiving most fees associated with treatment, a practice that is currently ending.

Now tack on the cost of a nursing-home stay or home health aide while you rehabilitate.

Add in an oxygen tank, inhaler, or any other medication you now require, and multiply that by the number of months it takes you to recover.

Factor in loss of wages, loss of productivity, and potentially even mental-health counseling.

What's your final bill?

"There is financial impact no matter how you look at it, and much of that has to be borne outside of the hospital," said Dr. Brian Kaminski, head of emergency medicine at ProMedica and vice president of quality and patient safety. "If they think they are going to put themselves at risk [by not getting vaccinated], it's important to know how far-reaching that may be."

For someone like Joanne Stanchin, who contracted coronavirus in July, 2020, the meter isn't done running.

The 67-year-old is one of the so-called long-haulers who experience symptoms months — and now nearly a year — after the initial infection. She has tested negative, she's been vaccinated, and yet the virus continues to affect her body and her wallet.

Her out-of-pocket costs, even with Medicare and private insurance?

— $1,200 deductible for her three-week stay in an intensive-care unit.

— $700 for her 60-day stay in an area nursing home, rehabilitating after the virus left her too weak to walk on her own.

— $62 per month rental fee on the lift now needed to leave her bed, since her strength was never restored.

— $15 per month for blood pressure medication, now required because of the damage the virus caused her heart.

— $15 per hour, three to four hours per day, seven days a week for a home health aide to help her shower and get ready for the day, now that the task is too challenging for her husband and sister to accomplish on their own.

— $220 per month to maintain her private health insurance and paid Medicare so that the cost of everything above can remain low.

In all, her direct cost of battling the virus in the hospital was $1,900. The bill she still pays each month while trying to recover? About $1,557.

"And I'm still getting them," Mrs. Stanchin said, motioning to a stack of hospital bills three inches thick on the stand near her bed in the living room of her northwest Toledo home.

What's more, her husband had to retire and turn his business over to their son in order to be her full time caregiver. It cut their monthly income in half.

"If you haven't been sick before, the cost of it is just..." she dropped the sentence with an exasperated and exhausted sigh. "Once you're a long-hauler, it doesn't go away."

Hospital stays are notorious for breaking the bank.

Being in the ICU and being on a ventilator is the most expensive type of care you could receive in the hospital, Dr. Kaminski said. Each day patients remain there, fighting for their lives, costs tens of thousands of dollars apiece.

Mrs. Stanchin's hasn't ever totaled the true cost of her 21-day stay, but leafing through a couple bills in a stack of more than 100 pages showed charges over $5,000 one day, $1,000 another and several hundred-dollar additions in between.

Because of insurance and other programs to offset those costs, no one actually ends up paying full sticker price anyway. But in the last year, at least 10 percent of ProMedica's patients still found they owed something.

"The low percentage is primarily due to many patients having secondary coverage [especially Medicare primary with a supplemental or Medicaid secondary], some commercial insurers waiving cost sharing, and Medicaid generally not having cost sharing on any hospitalizations," ProMedica spokesman Tausha Moore said.

For uninsured patients or those living under 200 percent of the Federal Poverty Guidelines, the cost of treatment could be zero. ProMedica is able to seek reimbursement for their care through other means.

Most commercial insurance companies, too, were waiving deductibles, copays, and other fees and costs for those hospitalized with the virus in 2020, which either eliminated out-of-pocket costs or at least kept them low.

In November, the Kaiser Family Foundation released a study showing that about 88 percent of people covered by insurance plans were able to have payments related to coronavirus treatment waived during the pandemic. But that practice has been quietly ending this year, shifting the cost-sharing back onto patients.

"We encourage Ohioans to proactively review their insurance benefits, coverage limits, and fees, and to communicate with their insurance company to address any questions they may have," Robert Denhard, an Ohio Department of Insurance spokesman, said in an emailed statement. "Each person's insurance situation can be unique."

ProMedica averaged the cost-sharing of every coronavirus patient in the last year and found that those on Medicare typically paid about $900 — Medicare does not waive cost-sharing — while those with commercial insurance paid about $1,500.

Much of the cost depends on a person's deductible. Should Dr. Kaminski become ill and require treatment, for example, his plan requires he pay at least $4,000, he said.

Whether a patient paid nothing upfront for their treatment or a couple thousand dollars may not matter in the long run, though, because "somebody is paying for that," he said. And it usually falls back on the consumer in the end.

"If those costs end up going up to the insurer, what we could see as insurees is the cost of our premiums going up," Dr. Kaminski said.

Even those who do not require hospitalization likely don't pay zero dollars toward their recovery. They may have lost money through unpaid sick time or needed to buy special foods, liquids, or medications to relieve some of the symptoms associated with the virus.

And what about future costs related to complications?

"There's not any official COVID set of symptoms, everybody's story is different, so [insurance companies are] questioning whether it's COVID-related or not and really getting obstinate about covering things," Mrs. Stanchin said.

Pain, in particular, is tricky to pin to a source, especially when Mrs. Stanchin had long battled debilitating arthritis. But that was a pain she was used to managing, she said. It didn't prevent her from caring for herself and moving around the house with a cane.

Then she got coronavirus, presumably from hugging friends while attending a funeral, and her life changed.

By the time she was discharged from the ICU to a nursing home for rehabilitation, "I couldn't even sit up. I couldn't even hold my arm up. It was like there was no muscle," she said.

Things didn't improve at the nursing home. Skin sensitivity, enhanced joint and muscle pain, pneumonia, and dangerous spikes in her heart rate when she tried to stand made physical therapy impossible. Her insurance ran out after 60 days, forcing her to return home unable to walk and bedridden.

She only recently was able to obtain a bed lift to allow her to access more of her home.

And it's not just the physical strength she's trying to restore. Though the sessions are currently on hold, she had recently been paying another $40 a week to receive counseling to address the trauma of her hospital stay.

Not only had it forced her to face her own mortality, she'd had to sit with those thoughts alone, in isolation. No one could visit. Her oxygen machine made it impossible to talk with her husband much by phone. Her room's television broke. Nursing staff mostly communicated with her in gestures through her room's window, rather than suit up to enter for non-emergencies.

"I just stared at the monitors and watched them beep ... there was a lot of isolation," Mrs. Stanchin recalled, her voice breaking. "I know in the grand scheme of things they said the TV wasn't a big problem, but I didn't have a bigger problem than dying, dying alone."

Returning home only to be bedridden sunk her further into depression.

"It got to the point where I would just sit here and cry for hours," she said, tears streaming down the right side of her face even then. "I feel sorry for the long haulers that are languishing somewhere."

There is a free solution to avoid the mental, physical, and financial cost of COVID, Dr. Kaminski says: "The vaccine works."

He credits the shot, which more than 42 percent of Lucas County residents have received, for reducing ProMedica's number of virus-related hospitalizations to a sixth of what they were at the pandemic's peak.

Of the coronavirus patients they're currently treating, 99 percent are not vaccinated, he said.

When Mrs. Stanchin contracted the virus, there was no vaccine available to prevent her from getting it or to at least reduce its severity, but she wonders how much hardship it could have spared her.

Coronavirus nearly cost her her life, she said. She's been paying for it ever since.

"If people knew they could have a heart attack just by standing up. If they knew they could be on oxygen for the rest of their life. If they knew they would not be able to walk or that they would not be able to go to the bathroom on their own, people would be running for the vaccine," she said. "Everyone thinks they're healthy, but COVID doesn't care how healthy you are."

First Published May 24, 2021, 7:00am

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