We the Patients

Facility Fee for Long COVID Care – Sam’s Story

As COVID-19 continues its spread across the country, a growing number of New Yorkers are experiencing persistent memory loss, nerve damage and other chronic neurological symptoms of long COVID. While much is unknown about long COVID at this stage, one thing is clear: the illness can be devastating to patients’ health, well-being and finances.

“Financially, COVID has murdered me.” Said Sam, a 51-year-old New Yorker living on Staten Island. After falling severely ill with COVID in March 2020 at an uncle’s funeral, daily tasks that Sam once did with ease – such as working with animals for her job as a Zoo Educator – became increasingly difficult for her to manage. As a result, she struggled to pay bills while seeking medical care for her neuropathy.

While her company’s first insurance provider covered co-pays for long COVID care, Sam was left responsible to cover those costs when her company switched to a different provider that did not. She had just paid the $126 co-pay of her $310 doctor’s visit when, just before the Christmas holiday, she discovered an even bigger bill lurking on her insurance provider’s web portal: $400, of which she was responsible for $277. After calling their billing department, she learned this large addition was a co-pay on a facility fee – a charge for the hospital’s overhead cost that is unfairly levied on patients.

At the time, Sam was working four jobs to pay her bills. She first tried negotiating the fee, assuming it to be an arbitrary cost like so many hospital charges. “I could not believe this was legal.” Sam said. Even though Sam works part-time as a patient insurance Navigator, her attempt at lowering her own cost of care was unsuccessful.

Next, Sam tried applying for financial assistance. Mt. Sinai denied her although she was eligible, saying assistance was only provided for inpatient care and not outpatient. In the end, she settled on a $20/month payment plan to chip away at the $277 she owed on the facility fee – that’s over a year of payments.

As 2021 came to a close, Sam received an email from Mt. Sinai in her inbox: a request for an end-of-year donation. “I was an old lady screaming at the screen. To ask me for money, are you kidding? It was a mind-blowing moment.”

Despite her frustration, Sam made clear that the care she received at Mt. Sinai’s long COVID facility was excellent. “My doctor saved me. I am not complaining about that in any sense.” Still, she worries that she’ll need to start looking elsewhere for care due to cost.

Sam urged others facing a similar situation to contact helplines like Access Health NYC and Community Health Advocates for immediate assistance. As the pandemic continues to impact New Yorkers, she also hopes more support and attention will be given to patients facing long COVID and other chronic conditions.

To read more about Sam’s battle with long COVID, read the article for the American Heart Association here. To read more about A3470A/S2521A – which would prohibit providers from charging facility fees that insurers will not pay – and take action, click here.

Image credit: Maheen Lemon/Dark Diary Images