At my dentist appointment in August, the receptionist told me I owed an extra $10 for the cost of personal protective equipment (PPE). I handed her my credit card without thinking much of it. A small “COVID fee” didn’t seem like a big deal. But, for some patients, these surcharges can create a barrier to accessing care. They can also show up in places you wouldn’t expect.
Many businesses, including restaurants, hair salons and nursing homes, now charge COVID fees to offset the higher cost of operating safely during a pandemic. PPE, temperature-screening supplies, disposable cups, heating lamps for outdoor dining — it all adds up.
In healthcare, COVID fees are found most often in dental offices, but other types of providers might impose them too. Healthcare providers with high aerosol exposure, particularly dentists, anesthesiologists and ENTs, have increased their PPE usage significantly, says Dr. Becky Bye, a dentist and healthcare attorney. While a primary care provider may only need to wear a standard surgical mask during a routine visit, a dentist needs an N95 mask and a face shield, plus PPE for their staff. These providers are also taking more precautions to prevent aerosols from lingering in the environment, says Bye. For example, some are implementing air-purifying systems and special suction devices that eliminate aerosols immediately.
PPE and cleaning materials are still in exceedingly high demand, and providers must pay a premium to stock an increased supply at a time when they’re seeing fewer patients and earning less money. “It’s not surprising that some offices are trying to find ways to cover these added costs of operating right now,” says Caitlin Donovan, senior director of the National Patient Advocate Foundation.
COVID fees vary from one practice or hospital to the next. For a dental procedure, Donovan says, they typically range from $10 to $45. Who pays those fees depends on your insurance provider. “Aetna generally does not reimburse doctors and dentists for Personal Protection Equipment,” Aetna told me by email. “PPE, like other disposable infection control supplies, is part of the cost of the underlying procedure.” However, some dental insurance providers, including United Concordia, Cigna Dental and Anthem, reimburse providers for at least part of COVID fees. And the American Dental Association is working to get fair reimbursement from more insurance plans.
“The ADA has recommended that dental benefit carriers should either adjust the maximum allowable fees for all procedures to cover the increased costs of PPE or [cover the extra fee],” the ADA told me by email. The ADA’s statement even encourages insurance companies to cover additional fees charged by any dentist, even if they’re out-of-network.
“The last thing any healthcare provider would want is for a fee to keep a patient from getting care.”
Some state governments and agencies are fighting COVID fees, too. In August, the New York State Department of Financial Services released guidance to New York health insurers saying that patients should not be charged fees for covered services beyond what is outlined in their insurance policies. In other words, patients should not be charged PPE fees unless their insurance plans explicitly mention them.
What to do about COVID fees
Your provider should tell you before your appointment if they charge a COVID fee. But don’t assume there isn’t one just because they didn’t mention it. It’s still smart to ask before your visit, Donovan says.
If there is a charge, contact your insurance company to ask if they cover all or part of the fee. If they don’t, you have options: You can either pay the full fee (or the remaining balance if it’s partially covered) or try to find another in-network provider who doesn’t charge them. Of course, that might be easier said than done.
If you can’t afford the fee, start by telling your provider. “This is probably the best way to get them not to charge it,” Donovan says. Bye adds: “Any dentist would be happy to know that a patient wants to see them and take care of their teeth, and there might be a way to work with them to be seen for necessary care. The last thing any healthcare provider would want is for a fee to keep a patient from getting care.” If the provider still says you need to pay the fee, tell them you need to cancel your appointment and will look elsewhere, Donovan says. That might push them to drop the charge. In some cases, a telehealth visit may help you avoid a COVID fee, but you’ll have to ask your provider if remote care is appropriate for your needs.
Lastly, there’s financial assistance. The Patient Advocate Foundation has a free directory of organizations that offer help. You can search by location, diagnosis or type of care. “Don’t assume that assistance is not available, or that you don’t qualify,” Donovan says. “We write a lot of $5 checks. There are millions of people for whom $5 is too far.”
But unless organizations like the ADA or state agencies create a nationwide shift, these COVID fees might be around longer than COVID itself. “For years, I’ve likened healthcare providers and insurers to the airline industry. Once a fee comes on, we never see it go away,” Donovan says. “My worry is that we are saying ‘COVID fee’, but we don’t know how temporary this is.” Even when the pandemic is truly over, providers might continue charging extra fees to help recoup losses they incurred due to COVID, she adds. It’s also unclear if providers will charge more for procedures and other services as a result, or if this will affect insurance prices, Bye says.
For now, my dentist plans to keep charging a COVID fee. When the office emailed to confirm my next cleaning, they wrote: “Please be aware that we have implemented a $10 fee to offset the cost of all of the enhanced PPE used to ensure the safety of our patients and staff.” I’m fortunate I can afford the fee, since my insurance doesn’t cover it. Bye says, “If it’s within your means, do not let it keep you from seeking regular care. Regular care is the least expensive way to avoid a more expensive issue in future.”
For those who can’t afford COVID fees, Donovan recommends speaking up. “Always stick up for yourself. Don’t be shy about saying you shouldn’t be charged a fee or can’t afford it.”