Uninsured or out-of-network patients who underwent inpatient care for COVID-19 paid a median charge of $45,683 if they were age 51 to 60 and $34,662 if they were 23 to 30.

That was one of the findings of the FAIR Health study, Key Characteristics of COVID-19 Patients: Profiles Based on Analysis of Private Healthcare Claims. Examining private insurance claims associated with COVID-19 diagnoses made between January and May, the report found the highest average allowed amount paid to a provider under an insurance plan was $24,012 for those between 51 and 60, and at its lowest, $17,094 for patients above 70.

"The findings show that costs vary by region, age and whether the cost under consideration is a charge amount or an allowed amount," Robin Gelburd, president of FAIR Health, told HCB News. "Charge amounts, which are billed to uninsured patients, are typically higher than allowed amounts, which are the total fees paid to a provider under an insurance plan. This difference may have an impact on access to care for patients who are uninsured."

The widest range of costs for COVID-19 hospitalizations were found in the West where the median charge amounts range from $21,407 for the 19-22 age group to $93,459 for the over 70 age group. Median estimated in-network amounts ranged from $15,289 for the 19-22 age group to $60,205 for the over 70 age group.

The virus on a national level was associated most commonly with patients between 51 and 60 who had 29.9% of the distribution of claim lines from January to May. They also had nearly identical shares in both rural and urban areas at 30.2% and 30.3%, respectively.

Claims lines on the national level were similar across all age groups in rural and urban settings, though regional geographic discrepancies were found. Patients between 19 and 30 and 31 and 40 in the South, Midwest and West, for instance, had larger shares of the distribution of claim lines than those in the Northeast and the nation as a whole.

The Northeast had the highest percentage of patients who received their initial COVID-19 diagnoses through telehealth, which was used more than emergency rooms for this purpose (6.7% versus 6.2%). Office settings, however, were the most common areas for initial presentation of patients with COVID-19 nationally and in every region except the Midwest. Of COVID-19 patients across the U.S., 33.3% were presented in an office, compared to 23% presented to an inpatient facility. Patients 61 and over were most commonly presented first to an inpatient setting, which was the most common venue in the Midwest.

A larger number of claim lines were also observed among males at 54%, compared to 46% of females, nationally. Children (patients between 0 and 18) accounted for the smallest share of claim lines at 1.5%. In addition, the study examined comorbidities, finding chronic kidney disease and kidney failure to be the most common among COVID-19 hospitalized patients at 13% between January and May. Type 2 diabetes was the second most common everywhere except the South where hypertension ranked higher.

These discrepancies according to Gelburd demonstrate the importance of profiles for COVID-19 patients and the potential applications they offer, such as risk determination, feedback for treatment protocols, setting priorities for eventual vaccination distribution, further research, and planning and budgeting around the use of healthcare resources. She adds that guidance on obtaining the most optimal care must be available to patients and providers throughout the pandemic.

“We offer a Quality Toolkit on our consumer website, www.fairhealthconsumer.org, that provides consumers with certain guidance about how to seek out quality information,” she said. “We also encourage all healthcare stakeholders to work together and offer transparency as needed to advance public health during this difficult time.”

The report is the fourth one conducted by FAIR Health on COVID-19.