A $22,368 Bill That Dodged and Weaved to Find a Gap in America’s Health System

John Druschitz spent five days in a Texas hospital last April with fever and shortness of breath. It was still the early days of the pandemic, and doctors puzzled over a diagnosis.

They initially suspected coronavirus and hung signs outside his door warning those entering to wear protective equipment. Mr. Druschitz had already spent two weeks at home with worsening symptoms. He recalls one doctor telling him, “This is what it does to a person.”

Ensuing lab work, however, was ambiguous: Multiple molecular tests for coronavirus came back negative, but an antibody test was positive.

Doctors found that Mr. Druschitz had an irregular heartbeat and blood clots in both his lungs. They sent him home on oxygen, and ultimately did not give a coronavirus diagnosis because of the negative tests. He didn’t think much about the decision until this fall, when he received a $22,367.81 bill that the hospital has since threatened to send to collections.

“I thought everything was good to go, and then I get the first bill in October saying I owe $20,000,” said Mr. Druschitz, 65, who retired in December.

Working with a patient advocate, he discovered that his debt stemmed in no small part from his diagnosis. Not having a coronavirus diagnosis disqualified his hospital from tapping into a federal fund to cover bills for people who do.

Mr. Druschitz ultimately fell slightly short of qualifying for multiple federal health programs that would have paid for his care if the details had been slightly different. Health policy experts see his experience as a case study in how easily patients can fall through the cracks of America’s fragmented health insurance system.

“It shows the insanity of having a health care system where literally the clinical diagnosis determines whether someone is going to get bankrupted,” said Dr. Ashish Jha, dean of the public health school at Brown University.

Mr. Druschitz is among more than 600 people who have submitted medical bills to a New York Times project tracking the high costs of coronavirus testing and treatment. If you have a bill to submit, you can do so here.

Most developed countries have a national system that provides health coverage to all residents. Some, like Britain, use a public health plan. Others, like Switzerland, rely on private insurers to cover all citizens with robust medical benefits.

The United States’ health coverage system is more of a patchwork: People qualify for different health programs depending on their age, employer and health status. The Affordable Care Act has increased coverage in recent years, but 29.6 million Americans still remain uninsured.

Mr. Druschitz was briefly among those uninsured millions. On the day the hospital admitted him, he was 64 years old, 23 days away from qualifying for Medicare. He had mistakenly terminated his private health plan, which he had purchased on the Obamacare marketplaces, one month early.

“My whole life I had insurance except this one month when all this happened,” he said.

If Mr. Druschitz’s hospital visit had happened 24 days later, Medicare would have covered the vast majority of the costs regardless of the diagnosis.

Because he was uninsured, the…