Nov 16, 2021 - Podcasts

Out-of-network costs spin out of control

People who have health insurance but get sick with diseases that require out-of-network care can face staggering costs.

  • Plus, the future of at-home COVID testing.
  • And, Florida’s special legislative session against mask and vaccine mandates.

Guests: Axios' Bob Herman, Kia Kokalitcheva and Selene San Felice.

Credits: Axios Today is produced in partnership with Pushkin Industries. The team includes Niala Boodhoo, Sara Kehaulani Goo, Julia Redpath, Alexandra Botti, Nuria Marquez Martinez, Alex Sugiura, Sabeena Singhani, Lydia McMullen-Laird, and Jayk Cherry. Music is composed by Evan Viola. You can reach us at [email protected]. You can text questions, comments and story ideas to Niala as a text or voice memo to 202-918-4893.

Go deeper:


NIALA BOODHOO: Good morning! Welcome to Axios Today!

It’s Tuesday November 16th. I’m Niala Boodhoo.

Here’s what we’re watching today: the future of at-home COVID testing. Plus, Florida’s special legislative session against mask and vaccine mandates.

But first, today’s One Big Thing: out-of-network health care costs spin out of control.

People who have health insurance but get sick with diseases that require out-of-network care can face staggering costs.

CINDY BECKWITH: My name is Cindy Beckwith. I live in Bolton, Connecticut. I was diagnosed in 2017, incidentally with a rare disease called fibromuscular dysplasia. My daughter at the time wanted me to see a doctor at the University of Pennsylvania in Philadelphia. My total out of pocket for the two surgeries was close to and around $20,000. I just have gotten the feeling that it has become more about the money than the patient care.

NIALA: Cindy isn’t alone. We found her because of Bob Herman, a health care business reporter at Axios who’s been investigating why the system works this way and what can be done about it. Hi, Bob.

BOB HERMAN: Hey, Niala.

NIALA: So federal regulations cap how much people pay out of pocket for in-network care, but there isn't a limit for out of network?

BOB: That's right. For any type of in-network care, if you go to an in-network doctor and in-network hospital, there is a maximum that people would have to pay out of pocket for that care. However, let's say you get a rare disease or a rare cancer and you have to go somewhere far out of state and that hospital and doctor is not in your insurance plan’s network there might not be a cap on that care. So that means if you need to go far out of state for really specific types of care, you could be on the hook for potentially all the costs. And that could be tens of thousands of dollars. It could be hundreds of thousands of dollars. It could be more. Obviously these are rare instances, but it could affect literally anyone of us.

NIALA: What would need to happen in terms of the system changing to avoid people being in the situation that Cindy is in?

BOB: So Cindy's situation, I don't know that there is an easy fix. Out-of-network care exists as a means to make sure that people go to doctors and hospitals that have agreed to see those patients. And the idea is if you stay within the network, we can control costs and you can still get good care within the network. There's really nothing out there right now to suggest that there will be a national network anytime soon. And that obviously gets into calls for Medicare-for-all, but obviously that is quite politicized.

NIALA: What does that say about our healthcare system in this country right now?

BOB: People in general whether it's in-network care or out-of-network care get bombarded with medical bills. They get something in the mail and it says they owe tens of thousands of dollars for, for care that obviously they're grateful for, but they're absolutely confused about how they even got there. What's being charged at them? People feel like they're just getting worked around in the healthcare system and the end result is they're getting slapped with these bills, even though they know they have insurance. But the bills don't make any sense to them. And I think that's, it's just, it's frustrating so many people right now.

NIALA: Bob Herman is a healthcare business reporter at Axios based in Valparaiso, Indiana. And Bob, you're actually doing this with other people apart from Cindy, you're trying to help people, including our listeners, figure out their medical bills.

BOB: That's right. If there's a medical bill that has left you feeling confused or angry, you know, we want to know about it. Let Niala know, let me know. My email is [email protected]. Let us know. We can maybe help out.

NIALA: Yeah, you can text me. You can email Bob. Thanks. Bob.

BOB: Thanks, Niala

NIALA: We’ll be back in 15 seconds with news on at-home testing in the U.S.

[ad break]

NIALA: Welcome back to Axios Today! I’m Niala Boodhoo.

So last week I was in the UK -- visiting family across England. It’s been two years since I’ve been able to travel to England because of the pandemic -- and things looked pretty different there right now than here at home. In cities like London and Cambridge, I saw few-to-no masks, and jam-packed bars, restaurants and clubs. But at-home COVID tests are easily accessible -- and much more a part of daily life than here in the US. That’s because the UK government has made them available, for free, to pretty much any resident that wants it.

We know that’s not the case here - but - as we continue to live with COVID in the U.S., at-home testing demand is likely to keep rising. One San Diego based company, Cue Health, which was known for providing COVID-19 tests to the Defense Department, Google and the NBA, is now selling consumer tests for everyone. Axios’ tech and finance reporter Kia Kokalitcheva gave us her review of this new entrant into the at-home testing space.

KIA KOKALITCHEVA: I got a chance to try out its testing device last week and it certainly had a number of great things going for it when I think about what I would want in a COVID test for my life. For one, it was easy to set up the little reader device connected to my phone with the company's mobile app and swab my nose with the testing cartridge. It gave me the results in less than half an hour.

The test is also a PCR equivalent with higher sensitivity than antigen tests which is what most of the at-home testing so far on the market has been. But on the downside, it's quite expensive. The reader itself costs about $250 and three cartridges for testing are $225, much more than the tests from companies like Abbott and Quidel, which costs about $24 for a two-pack of antigen tests that you can take at home and you can purchase at a pharmacy or online through Amazon or other retailers. Pricing will be key in making sure that at-home COVID testing is accessible to as many people as possible.

NIALA: That was Axios’ Kia Kokalitcheva. And over the next month we’re going to be bringing you updates on what you need to know about living in a COVID world we head into winter and the holidays. That includes the latest on boosters. And on that are vaccines factoring into your Thanksgiving or other winter holiday plans? Tell us by texting a voice memo to me at (202) 918-4893. Don’t forget your name and where you listen from.

Florida's Governor Ron DeSantis called state lawmakers back to Tallahassee yesterday for a special session. The goal: to pass laws to keep businesses, hospitals and schools from enforcing covid mask and vaccine mandates.

Axios Tampa Bay’s Selene San Felice is here to explain what’s going on in Florida and why it matters. Selene, so for example, if a hospital has a vaccine mandate in place for its workers, what is governor DeSantis trying to do about that?

SELENE SAN FELIXE: Governor DeSantis is essentially trying to make sure that people who don't want to get the vaccine, don't have to get the vaccine if it's mandated by their workplace. And he's attempting to try and also do that if it's mandated by their school or the government. He has called lawmakers back to Tallahassee because he has a bunch of bills that he wants to get passed. Those center essentially on employees trying to get them the ability to opt out of covid vaccine mandates, um, with more exemptions, like pregnancy, expected pregnancy, which would be like, I think if you're, if you're trying to get pregnant, religious regions and immunity from previous infection. As well as also making sure that employers who fire people for refusing to get vaccinated are actually hit with a $50,000 fine or they have to reinstate that employee that they fired for violating the mandate.

NIALA: And so how have businesses responded because businesses are trying to comply in some cases with federal vaccine mandates?

SELENE: Right. I mean, this seems like depending on how this week goes, it could create a lot of confusion in terms of what is state mandated, what is federally mandated? The debates here are still really tense, as to whether people want to get vaccinated and still as to whether they want to wear masks in places that they're required to wear masks.

NIALA: Selene, Governor DeSantis has dubbed the special session “Keep Florida Free,” how much of this is about challenging president Biden directly?

SELENE: It's not necessarily about challenging president Biden, uh, but more so it's about appealing to his base. So, he just launched his gubernatorial campaign for reelection for 2022. And his name has been mentioned a lot, in the race for 2024 against Biden. So, whether it's for governor or for president, he is definitely doing this to appeal to his base.

NIALA: That's Axios Tampa bay, Selene San Felice. Thanks, Selene.

SELENE: Thank you.

NIALA: That’s all we’ve got for you today!

I’m Niala Boodhoo - thanks for listening - stay safe and we’ll see you back here tomorrow morning.

Go deeper