Federal law says uninsured COVID patients should be treated for free. Why did Orlando Health tell CJ Vogl he owed $29,000?

Orlando Health told CJ Vogl he owed $55,923 after five nights' treatment for COVID, then cut it to $29,000. But under federal law, his cost of services was supposed to be $0.
Orlando Health told CJ Vogl he owed $55,923 after five nights' treatment for COVID, then cut it to $29,000. But under federal law, his cost of services was supposed to be $0.

When CJ Vogl awoke at 2 a.m. in his Charleston, South Carolina, Airbnb with a strange feeling in his chest and stomach, he assumed his acid reflux was acting up. But then he threw up — and he kept throwing up, retching to the point of near delirium, he says. He tried to sleep off his worsening sickness, but when his girlfriend also began experiencing flu-like symptoms, they feared the worst.

They'd both received their second Moderna vaccine a week or so earlier, says Vogl, 25. But that didn't stave off the Delta variant tearing through Florida in mid-August, infecting more than 20,000 people a day. So on Sunday, Aug. 22, their weekend getaway ended with a painful six-hour drive home to Orlando.

By Wednesday, Vogl was struggling to take deep breaths, and an over-the-counter pulse oximeter showed his blood-oxygen level at 87 percent, which is considered low. He checked into the Orlando Health's Orlando Regional Medical Center, where he spent the next five nights. The care was excellent, he says. But Vogl, who doesn't have health insurance, was worried about the bill.

When his Orlando Health patient portal said he owed only $100, he called ORMC's billing department to see if that was correct.

"Oh, no," he says he was told. "We're still totaling everything up. Your cost of services is about $55,900."

Vogl was stunned, he says. He didn't know then — he didn't know until last week, when he was informed by Orlando Weekly — that under federal law, his cost of services was supposed to be $0. Two days after he mentioned the law in a phone call and email to Orlando Health's billing department, Vogl's patient obligation was erased, according to screenshots of his patient portal provided to Orlando Weekly.

His story raises two important questions: Had Orlando Weekly not made Vogl aware of a federal law designed to help uninsured COVID patients, would the hospital have tried to collect what it said Vogl owed? And are other uninsured COVID patients unnecessarily struggling to pay Orlando Health bills, or bills from other hospitals?

Orlando Health spokesperson Kena Lewis points out that Vogl was never sent an invoice requesting payment. She adds that it's "highly unlikely" that a patient who is eligible for free COVID care could slip through the hospital system's cracks.

"Our experience with uninsured patients is that they are often unaware of coverage for which they may be eligible," Lewis says. "That's why we have teams of people to help them see what they might quality for."

In its response to the pandemic, Congress established a COVID-19 Uninsured Fund, which reimburses providers at Medicare rates for treating uninsured COVID victims at no cost to the patient. ORMC has received almost $5 million in reimbursements, federal records show. Orlando Health's other facilities have been reimbursed more than $1.8 million.

Lewis says that patients are "advised that they may be eligible" for free COVID care. But Vogl says no one told him. Hospital officials collected his information. They knew he was uninsured. The hospital then gave him a "self-pay" discount, which reduced his obligation from $55,923 to a hair under $29,000.

On Sept. 2, he emailed Orlando Health to ask about financial assistance. Five days later, a representative emailed him a link, according to emails he provided to Orlando Weekly. As a nonprofit, Orlando Health — which in 2019 earned nearly $509 million in income against more than $2.7 billion in revenue, according to tax filings — is required to provide assistance to low-income patients. It writes off care for patients with household incomes at or below 225 percent of the federal poverty level — currently $28,980 for an individual or $59,625 for a family of four — which added up to more than $76 million in 2019, Lewis says.

Between Vogl's bartending gig at the Orlando beer bar Redlight Redlight and his full-time job at Aspire Health Partners, where he helps men with substance-abuse issues, Vogl believed he made too much to qualify. (Aspire offers its employees health insurance. Vogl took the job last November but didn't complete the paperwork before his enrollment period ended, he says. He'll become eligible to enroll again in October.) He applied for financial assistance but says he didn't hear back.

While Lewis says she can't discuss specific patient information, she says Orlando Health only reviews applications for financial assistance after it evaluates eligibility for the COVID-19 program. That can sometimes take weeks, she adds. After physicians document the patient's case, the hospital requests a patient ID from the Centers for Medicare & Medicaid Services, then submits a claim and waits for approval.

Staring down a $29,000 bill he had no hope of paying, on Sept. 18, Vogl started a GoFundMe campaign.

"I am so grateful that I went to Orlando Health when I did," he wrote. "Otherwise, it's entirely possible we aren't even having this conversation right now.

"However, the thing here is that I'm uninsured and thus am dealing with a medical bill that is currently impossible for me to pay even if I allow myself to go totally broke paying it."

To date, it has raised more than $3,100 from 64 donors.

Orlando Weekly learned of the campaign on Sept. 22, contacted Vogl and told him about the COVID-19 Uninsured Fund. He called Orlando Health's billing department and the person who answered seemed to have no idea what he was talking about, he says. Then he emailed the hospital's patient advocate: "I was wanting to inquire into my options here. With the knowledge of [this fund], what could we go ahead and do?" He received an automated reply.

Within 48 hours, however, Orlando Health had updated his bill. There was now a line called "Insurance Paid" totaling $39,247.62, with the "primary payer" listed as the COVID-19 Uninsured Fund. Vogl's obligation was zeroed out.

There's no obligation for hospitals to inform patients about the fund — and some don't, according to an investigation last year by Kaiser Health News and Nashville Public Radio. In some cases, emergency providers — who must treat everyone regardless of their ability to pay — did not want to take the legal risks associated with asking about patients' insurance status. In others, there was simply a lack of awareness.

Vogl's GoFundMe campaign implicitly, and perhaps inadvertently, spread this misinformation: that people without insurance who go to the hospital for COVID treatment could end up with massive bills and crushing medical debt.

The consequences of such misinformation can be deadly. Uninsured patients often avoid care so as to avoid bills they can't pay. Research published by the consumer advocacy group FamiliesUSA linked 32 percent of COVID deaths nationally — and 48 percent in Florida — during the first eight months of the pandemic to gaps in health insurance coverage.

Jeff Grainger, a spokesperson for the Altamonte Springs-based hospital system AdventHealth, says AdventHealth's "financial folks meet with patients while they're in the hospital if it's feasible."

"We would let a patient know that we would submit a claim to [the COVID program] on their behalf, but that's not able to be done until after they're discharged, and of course there are no guarantees," Grainger continues. "[If] they don't qualify under the [COVID] program, then our financial assistance policy is applied, leaving them no out-of-pocket expenses."

AdventHealth's financial assistance policy covers only those making up to 200 percent of the federal poverty limit — in 2021, that's $25,760 for an individual.

A month after being hospitalized, Vogl says he's getting back to normal.

"I sweat a lot, even with small exertions," he says. "I can't take, like, a full, deep breath yet. I'm still getting there."

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