A dentist (left) and dental hygienist wearing full COVID-19 personal protective equipment perform a procedure in August at Piedmont Health in Carrboro. Brad Blackburn / NC Oral Health Collaborative.

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When Brianna Briggs of Clayton went to her dentist’s office for a cleaning, she saw a new sign on the front door informing patients of a new $20 fee to cover personal protective equipment costs. 

Even though Briggs had dental insurance, the $20 fee was added after the insurance adjustment was already made, meaning that she bore the full cost. 

“It’s obviously not ideal, but neither is dying of COVID,” Briggs said. “So, I’ll take an extra fee if it means me or the dentist won’t die.”

Due to the worldwide surge in demand for PPE, many consumers have found PPE surcharges listed on their medical and dental bills.

Dentists are small-business owners with extremely high overhead,” said Lisa Ward, associate executive director of the N.C. Dental Society. “Many (dentists) can’t absorb increased costs as easily as a large health care system or a large physician practice.”

Some consumers, like Briggs, are not informed about the charges until they arrive for the service. These kinds of situations have led to concerns that businesses may not be properly informing consumers of increased prices.

Surprise bills and health care pricing transparency issues have existed long before the pandemic, but consumers are now reporting that they were not notified of COVID-19 fees until they received their bill. 

“There is no law or regulation administered by the Department of Insurance that requires health care providers to publish their charges before they receive services,” Barry Smith, assistant director of public affairs at the N.C. Department of Insurance, said.  

Though several consumers have called the department about surprise fees, none have filed a formal complaint yet, said Insurance Commissioner Mike Causey. If a provider is going to charge a fee, “my thinking is that they should have to disclose that to the consumer,” he said. 

While “businesses are allowed to pass along reasonable COVID-19-associated costs” to consumers, “our office does take the position that additional billings should be disclosed before a procedure,” said Laura Brewer, communications director at the N.C. Department of Justice.

State Treasurer Dale Folwell said he was aware of the same complaints as Causey, but “because (the hospital) industry works in secrecy, it’s almost impossible to properly investigate whether there are upcharges being billed.”

In other states, long-term care facilities have billed patients for COVID and PPE fees.

So far in North Carolina, no official complaints regarding fees have been filed with the State Long-Term Care Ombudsman’s Office, said ombudsman Victor Orija

Increasing costs

An increase in the costs of PPE as the pandemic wears on creates a financial burden on some providers. 

Thomas Hughes, a spokesperson for UNC Health system, said prices for safety equipment such as N95 masks are sometimes as high as 500% more than the price a year ago. UNC Health has not implemented additional fees for PPE.   

In long-term care facilities, a decrease in demand creates additional pressure for income. A survey by the N.C. Assisted Living Association members found their facilities housed 10%-15% fewer residents than before the pandemic. 

“We know our communities have been hurt economically by decreased census as well as the expenses for cleaning supplies and PPE,” said Frances Messer, president and CEO of the trade association. 

“It’s very difficult to say what is having a greater impact — specific COVID surcharges or supply costing more,” said Jane Ryngaert, an assistant professor of economics at Wake Forest University.

Some businesses in industries outside of health care are adding fees to offset the increased costs of cleaning supplies, masks and other equipment to prevent the spread of the coronavirus. 

Simone Kelly, the store manager at Adelaide’s Salon in Wilmington, said the business began charging a $5 “COVID fee” when it reopened at the end of May after being closed for two months. 

“In the beginning, everything was so hard to get, and it was very expensive. All these charges fell on us,” Kelly said. “We charged an extra $5, we called it a COVID fee, and not one of our customers blinked an eye. … They were here for us.” 

Increased supply costs, not only for PPE but also for other supplies, have pushed businesses to increase consumer costs. 

“In the end, whether a hairdresser is buying PPE or a restaurant is spending more on food, the specific disruption doesn’t matter,” Ryngaert said. “In both cases, the cost of doing business is higher and will be shared by the consumer.” 

Not only was Kelly’s store paying for PPE and cleaning supplies, she said, but the hair products it uses were also more difficult to find.

“Even trying to get supplies — our colors and our product — the manufacturer’s shelves were empty,” she said. “We were having trouble even getting product to do anything in the beginning.” 

Salons were not the only businesses affected. Restaurant owners were also stressed by rising supply costs. 

International food prices increased for the fifth month in a row in October, according to a report by the U.N. Food and Agriculture Organization, leading some restaurants either to charge COVID surcharges or raise menu prices to make up for lost revenue.  

Businesses like Adelaide’s Salon recognize increased prices are unpopular with customers, especially those who may be experiencing economic difficulties in light of the pandemic. 

Adelaide’s is phasing out its $5 COVID fee to help people during the holiday season, Kelly said. Some of the business costs have also decreased.

“You know, we’re really kind of caught up now,” Kelly said. “It’s easier to get what we need and it’s not costing as much as it used to, so we thought taking off the COVID fee was a nice gesture for the holidays.”

Who pays?

When providers bill for a COVID-related charge, patients with private insurance may have to pay for these fees out of pocket.

Blue Cross NC, the largest private health insurance provider in the state, does not reimburse individuals for separate PPE charges.

“Because infection control is always inherent to providing medical services, Blue Cross NC does not cover personal protective equipment when billed separately from the services provided,” a Blue Cross NC statement said. 

The federal government temporarily increased Medicare reimbursement rates by 20% for treatment of patients with COVID-19, but there is no specific provision for PPE fees.

The federal Department of Health and Human Services launched a program in late April to cover the cost of COVID-19 treatment for anyone without insurance, although hospitals often forget to inform patients that they owe nothing.

While treatment may be covered, the additional surcharges for PPE can be an added cost to the consumer.

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Christian Green

Christian Green is the lead Carolina Public Press contributing writer reporting on healthcare and health policy in North Carolina. He obtained a master’s degree in neuroscience at Wake Forest University’s Graduate School for the Arts and Sciences, where he worked in the Laboratory for Complex Brain Networks. He is based in Raleigh. Contact him at cgreen@carolinapublicpress.org.

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  1. Companies that manufacture and also the companies that sell PPE need to be regulated so they don’t price gouge consumers during the pandemic. If we are all in this together, right?

  2. As I watch businesses struggle, the divide along partisanship lines across our nation grows with talk substituting for action i.e. policy. I am 71 and I wonder will the nation heal and repair the damage done to the people, businesses, health care providers of this faltering nation?