Novel coronavirus test for Miami man leads to $3,275 bill | Miami Herald

After returning to Miami last month from a work trip in China, Osmel Martinez Azcue found himself in a frightening position: he was developing flu-like symptoms, just as coronavirus was ravaging the country he had visited.

Under normal circumstances, Azcue said he would have gone to CVS for over-the-counter medicine and fought the flu on his own, but this time was different. As health officials stressed preparedness and vigilance for the respiratory illness, Azcue felt it was his responsibility to his family and his community to get tested for novel coronavirus, known as COVID-19.

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He went to Jackson Memorial Hospital, where he said he was placed in a closed-off room. Nurses in protective white suits sprayed some kind of disinfectant smoke under the door before entering, Azcue said. Then hospital staff members told him he’d need a CT scan to screen for coronavirus, but Azcue said he asked for a flu test first.

“This will be out of my pocket,” Azcue, who has a very limited insurance plan, recalled saying. “Let’s start with the blood test, and if I test positive, just discharge me.”

Fortunately, that’s exactly what happened. He had the flu, not the deadly virus that has infected tens of thousands of people, mostly in China, and killed at least 2,239 as of Friday’s update by the World Health Organization.

But two weeks later, Azcue got unwelcome news in the form of a notice from his insurance company about a claim for $3,270.

In 2018, President Donald Trump’s administration rolled back Affordable Care Act regulations and allowed so-called “junk plans” in the market. Consumers mistakenly assume that the plans with lower monthly costs will be better than no insurance at all in case of a medical catastrophe, but often the plans aren’t very different from going without insurance altogether.

Hospital officials at Jackson told the Miami Herald that, based on his insurance, Azcue would only be responsible for $1,400 of that bill, but Azcue said he heard from his insurer that he would also have to provide additional documentation: three years of medical records to prove that the flu he got didn’t relate to a preexisting condition.

While Azcue’s experience shows the potential cost of testing for a disease that epidemiologists fear may develop into a public health crisis in the U.S., one insurance expert sees the episode as a cautionary tale about the potential risks associated with deregulation in the insurance market.

“When someone has flu-like symptoms, you want them to to seek medical care,” said Sabrina Corlette, a Georgetown University professor and co-director of the Center on Health Insurance Reforms. “If they have one of these junk plans and they know they might be on the hook for more than they can afford to seek that care, a lot of them just won’t, and that is a public health concern.”

Azcue said he earns about $55,000 a year working for a medical device company that does not offer health insurance, but his insurance plan wasn’t always so narrow. Last year, Azcue said he was covered under an Affordable Care Act-compliant plan that cost him about $278 in monthly premiums.

Those premiums shot up to $400 a month when his full year salary kicked in, so he canceled his plan in November, he said. Azcue said he now pays $180 per month for the limited plan from National General Insurance.

The limited plan’s requirement to provide three years of medical records before coverage kicks in, Corlette said, is not uncommon. The professor said she’s seen it come up for conditions like cancers that were never diagnosed but might have been hinted at in doctors’ visits from years past.

“That’s the critical difference between [Affordable Care Act] plans and junk plans,” she said. “[Junk plans] will not cover preexisting conditions.”

A spokesperson for National General Insurance did not immediately respond to a request for comment.

Jackson Health officials say that there are more bills for Azcue on the way, but it’s unclear what those will total, as they are going to be issued by the University of Miami Health System, or UHealth, for treatment provided by their staff physicians who work at Jackson.

Azcue said his experience underscores how the costs of healthcare in the U.S. could interfere with preventing public health crises.

“How can they expect normal citizens to contribute to eliminating the potential risk of person-to-person spread if hospitals are waiting to charge us $3,270 for a simple blood test and a nasal swab?” he said.

Plans that comply with the Affordable Care Act often have high deductibles, too, Corlette said, but are likely to provide more reimbursement than the more restricted plans. Plus, she added, those ACA plans are required to cover flu shots and other preventative care.

“The idea that [the insurer] would have to comb through three years of his records just to determine if the flu was a preexisting condition is just crazy,” Corlette said. “But that’s how most of these plans operate.”

This story was originally published February 24, 2020 10:01 AM.