Couple snagged by major problems in American health care: very high billing, obscure pricing, high-deductible insurance plans, and few care options in rural areas.

By Blake Farmer, Nashville Public Radio

Jason and DeeAnn Dean recently relocated to her hometown of Dellrose, Tennessee, where she grew up on a farm. Both in their late 40s, they’re trying to start a green dream business that combines organic farming with a health and wellness consulting company. They want to inspire people to grow their own food in this fertile rolling farmland, just north of the border with Alabama.

Until the business fully launches, Jason is working construction. In May, he was injured on the job site when a piece of sheet metal slipped and caught him on the kneecap. He bled quite a bit. After closing the wound with a butterfly bandage, he thought that might be enough. But on his drive home, he figured it’d be best to have a professional stitch it up.

It was late in the day, and the emergency room seemed the best option since his doctor’s office was closed. He and DeeAnn had opted for a health plan with lower monthly payments and a high deductible. So, he knew the cost of care wouldn’t be cheap — and he was right. When the bills for thousands of dollars came, they were shocked. They were in the midst of fighting them in August when DeeAnn started feeling as bad as she’s ever felt.

“I haven’t eaten. I’m not drinking. I have a horrible fever. I can’t get out of bed. I’m shaking,” she said.

She was pretty sure she had contracted covid-19 — the delta variant was surging across the South. The natural-health fanatic was kicking herself for putting off vaccination. She got tested and the result was negative. She visited a doctor the next day, who said her condition was bad enough to go to the ER — but she regarded that option as financially unacceptable.

“That is fear,” said DeeAnn. “If they charged Jason this much, what would they charge me?”

She was terrified of a potential bill from the same ER in Pulaski, Tennessee, that had treated her husband. So even though she was deliriously ill, she hit the road in search of cheaper treatment, asking her parents to drive her. They headed south first to an ER in Huntsville, Alabama, but it was so full of covid patients, she would have had to wait all day. Then, they drove north nearly an hour to Maury Regional Medical Center, a public hospital in Columbia, Tennessee, where she was diagnosed with Rocky Mountain spotted fever, a potentially deadly tick-borne infection. She got treatment with appropriate antibiotics and IV fluids.

“I would have had organ damage or possibly death in a few days,” she said.

And then the bills came.

The Patients: Jason and DeeAnn Dean, entrepreneurs and aspiring organic farmers who bought a BlueCross BlueShield of Tennessee insurance plan with a deductible of $8,000.

Medical Services: Jason received six sutures for a laceration on his knee and a tetanus shot. DeeAnn received diagnosis and treatment for Rocky Mountain spotted fever.

Total Bills: Jason was charged $4,582.77 by the hospital for a Level 4 emergency visit, including $497.40 for a tetanus shot. The ER physicians who treated him sent a separate bill of $2,007, for a total of $6,589.77. The Deans’ share of these bills came to $4,278.05. At a different ER, DeeAnn was charged for a Level 4 emergency and lab tests. BCBST paid a negotiated rate of $1,990.63 and the Deans owed $566.33.

Service Providers: Jason received care at Southern Tennessee Regional Health System-Pulaski, part of the LifePoint Health hospital chain. DeeAnn received care at Maury Regional Medical Center, a county-owned hospital in Columbia, Tennessee, about twice as far from her home as the Pulaski hospital.

What Gives: The Deans were snagged by a host of major problems in American health care: very high billing, obscure pricing, high-deductible insurance plans and few options for care in rural areas. The net result could have cost DeeAnn her life.

When Jason went to the only local ER for stitches, the staff assured him his insurance would cover the treatment. “I’m not versed in medical billing or medical law,” he said. “So I said, ‘Let’s go ahead and stitch it up.’”

It took 30 minutes. Despite his questions about coverage, no one ever told him what he would be charged. He guessed no more than $1,000 for the 30-minute visit.

Then, a few weeks later, he began receiving bills. The hospital charged a total of $4,582.77, asking him to pay $3,391.25 for his six stitches.

LifePoint Health, the hospital’s owner, is a large hospital chain headquartered in Nashville that specializes in rural hospital operations. The ER physicians, who sent a separate bill for $2,007 (discounted to $886.80), are part of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of moderate complexity.

Both the physicians and the hospital are part of companies recently taken over by private-equity investors. TeamHealth has been sued by the nation’s largest health insurer, UnitedHealthcare, for overusing Level 4 and Level 5 charges on bills. It’s a practice insurance companies refer to as “upcoding.” TeamHealth calls the accusation an attempt at “downcoding” a physician’s expertise.

Both companies, through spokespeople, essentially said Jason’s charges are what they are. LifePoint wouldn’t discuss specifics.

DeeAnn was still worried about her Maury Regional bill, especially after a battery of tests and being hooked to IV fluids. But, despite the high level of care she received and having the same high-deductible plan as her husband, she’s out only $600 — an amount she said she will gladly pay.

As is so often the case with Bill of the Month sagas, the question of responsibility has all sides blaming the others. TeamHealth, the ER staffing firm, which controls billing in an estimated 17% of all emergency rooms, blames insurers for selling high-deductible plans. And patients.

“Unfortunately, it is all too common that patients are not knowledgeable about their financial responsibilities under high-deductible plans,” TeamHealth spokesperson Greg Blair said in a written statement.

And the high prices do come at a cost for people’s health. For 1 in 10 Americans, according to the Peterson-KFF Health System Tracker, costs cause patients to put off necessary care.

Resolution: The Deans spent hours on the phone, asking the hospital and the physicians’ group to review the charges for Jason’s $1,000-per-stitch care. Both companies are sticking by the original bills. But the Deans are still fighting.

DeeAnn said they regret gambling on a high-deductible plan. But the difference in monthly premiums was substantial compared with low-deductible plans, especially when they’re launching a business, and the risk seemed minimal given their lack of chronic conditions and focus on healthy living.

Pulaski is lucky to still have a hospital, though. Southern states — and Tennessee especially — have seen rural hospitals close faster than anywhere else in the country. It’s a phenomenon routinely blamed on the lack of Medicaid expansion, which leaves many people uninsured.

“I get it,” DeeAnn said. “But that doesn’t mean they get to take advantage of the people going through there.”

The Takeaway: It is a national tragedy that many Americans avoid or defer needed medical care because of fear of costs. Still, there are steps you can take to protect yourself.

Emergency rooms are expensive places, so think twice before using them — although, in many circumstances, they are the only option on nights and weekends, particularly in rural areas.

Don’t be reassured by a provider’s insistence that your insurance should cover treatment. If you have a high-deductible plan, “you’re covered” doesn’t mean much because you’re responsible for — in Jason’s case — the first $8,000 in charges. Also, even if your insurer, in theory, covers your medical encounter, you may receive big bills from doctors outside your network or be required to contribute a hefty coinsurance share under the terms of your plan.

You can ask whether the self-pay cash price is an option — thereby waiving your insurance. But many facilities will require those who have insurance to use it — knowing they can bill higher prices that way.

If a physician gives you the option of having a lab test, MRI or X-ray on the spot in the ER versus doing it once you’re discharged, choose the latter. Tests run while in the ER are often many times more expensive than elsewhere. After your visit, check how it was coded. If the bill says Level 4 or 5 and the visit was fairly simple, ask more questions. Here’s a handy chart with descriptions of the five CPT (current procedural terminology) codes for the levels of ER service.

Finally, it’s worth knowing in advance who staffs the emergency departments of hospitals in your area, especially if you have a high-deductible plan. Are the doctors employed by the hospital or are they employed by a private-equity-owned staffing firm? The latter type of arrangement, research shows, often means high prices and more aggressive billing. Driving a few extra miles could save thousands of dollars.

Travel insurance generally covers only emergency or urgent medical expenses, according to the California state insurance commission, which regulates policies in the state.

This article was published on Thursday, November 18, 2021 in Kaiser Health News.

By Arthur Allen

Duy Hoa Tran, a retired Vietnamese schoolteacher, arrived in Los Angeles in February 2020 to visit his daughter and 2-month-old grandson. Two weeks later, the door closed behind him. To prevent the spread of covid-19, Vietnam shut its borders. No commercial flights would be allowed into the country for the next 18 months.

Tran’s daughter, An Tran, who has a doctorate in business administration and teaches marketing at the University of La Verne in California, did what she thought was necessary to ensure medical coverage for her then-65-year-old father during the pandemic. But the only option for a visitor on a tourist visa was travel insurance. In early March 2020, An Tran found and purchased a policy, for about $350 a month, from a company called Seven Corners.

She might as well not have bothered.

The elder Tran had been staying at An’s home in Diamond Bar, California, about a year when he told his daughter he was having trouble seeing out of his right eye. A visit to an ophthalmologist produced a solemn verdict: Tran had severe glaucoma and would quickly go blind unless he got surgery.

Seven Corners gave written preapproval for the procedures recommended by Dr. Brian Chen. To be safe, An Tran called the insurer “many times” to confirm it would cover the expense, but no one she spoke with would give her a definitive answer, she said. Chen, however, assured An that insurance companies typically covered the treatment, which was pretty routine.

On April 19, Tran underwent the first of three eye surgeries to resolve the glaucoma. The surgeries — the last was on July 19 — were successful. And then on Aug. 5, Seven Corners sent An Tran a denial of service letter.

The company’s policy excluded coverage for any “preexisting condition,” by which it meant any condition “whether or not previously manifested, symptomatic, known, diagnosed, treated or disclosed,” the letter said.

An Tran and her father were on the hook for nearly $38,000 in medical bills, although Seven Corners had preauthorized the surgery and she had paid around $6,000 for the insurance over the previous year and a half.

As for the bill, “my dad obviously can’t pay it,” Tran said. His $260 monthly pension from the Vietnamese government isn’t enough even for him to live on in Vietnam, she said.

The surgical procedures Duy Hoa Tran received are quite routine in the United States, said Dr. Davinder Grover, an ophthalmologist in the Dallas area and clinical spokesperson for the American Academy of Ophthalmology.

Medicare would generally pay about a quarter of the $37,896.83 Tran was billed for the surgeries, Grover said. If Tran’s daughter had known beforehand that insurance wouldn’t cover the procedures, the physician’s practice might have been willing to charge something like $12,000, he said.

The policy An Tran purchased had no deductible and offered coverage of up to $100,000 in medical bills, including covid care. But travel insurance generally covers only emergency or urgent medical expenses, according to the California state insurance commission, which regulates policies in the state.

Megan Moncrief, chief marketing officer for Squaremouth, which aggregates various companies’ travel insurance plans — including some from Seven Corners — and offers them through its website, said the policy language was not unusual for travel insurance. She noted the policy’s stipulation that it covered some acute conditions only if the patient sought treatment within 24 hours of the initial symptoms.

Moncrief said the fact that Tran did not seek treatment immediately may be the reason his surgeries weren’t covered. (Seven Corners refused all comment on the case.) She acknowledged it was hardly surprising he hadn’t dashed to the doctor at the first sign of discomfort: “I don’t know that I would have done that either, if I just had blurry vision.”

As for Seven Corners’ refusal to pay despite precertification, this is not uncommon, she said. By precertifying, the insurer verifies that a procedure is a covered benefit but doesn’t guarantee the insurer will cover it for that particular patient.

Travel insurance typically offers little protection for any health problem linked to a preexisting condition, regardless of whether that condition has ever been diagnosed, says Susan Yates, general manager in the U.S. for Falck Global Assistance, an international insurer.

“For visitors to the U.S., especially those who are not permanent residents or citizens, it can be difficult to obtain health insurance,” she said. The Affordable Care Act doesn’t cover tourists, though some resident noncitizens can buy coverage.

“It’s usually better for a visitor to buy travel insurance from their country of origin, but in some countries (Vietnam being one), the insurance market is not developed,” Yates wrote in an email.

Tran had tried unsuccessfully for months to fly home to his town near Ho Chi Minh City, where his wife lives with another grandchild. On 14 occasions, An bought him tickets on regular commercial flights that were subsequently canceled. He was also unable to get a seat on charter flights arranged by the Vietnamese government; those tickets generally were available only through third parties charging up to $10,000.

The eye surgeon, Chen, offered to discuss the case with KHN, but his medical group’s counsel said it had a policy against discussing insurance issues with reporters, even with the patient’s consent.

After KHN approached him to discuss the issue, Chen told An Tran that he was waiving his $8,144 fee for the surgeries. The Acuity Eye Group, where he practices, would not immediately confirm Chen’s offer, but told An Tran they were seeking approvals to waive his fee and all other charges as well.

On Sept. 15, Duy Hoa Tran finally managed to get on a charter flight back to Vietnam. He’s happy to be home, An Tran said.

Under California’s filial responsibility laws, she could be liable for his remaining bills.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

In the past, even when contract negotiations became publicly antagonistic, they typically would be resolved before the deadline for termination.

This article was published on Wednesday, November 17, 2021 in Kaiser Health News.

By Andy Miller

In September, when Shelly Azzopardi went to Wellstar Kennestone Hospital with abdominal pain, she didn’t worry about her insurance.

Doctors said she had a case of appendicitis. But she also tested positive at the hospital in Marietta, Georgia, for covid-19. Physicians decided not to do surgery and treated her with antibiotics and painkillers. Azzopardi, 47, went home after a couple of days in the hospital, feeling better.

But in October, the appendix pain again flared. Her husband took her to the same hospital, where surgery was performed successfully. This time, though, she ran into a snag with her insurance.

Azzopardi has UnitedHealthcare coverage, and as of Oct. 3, Wellstar Health System was no longer in the giant insurer’s network, after the two sides did not agree on a new contract.

Wellstar dominates the Cobb County area where Azzopardi and her husband live. She has applied to UnitedHealthcare for a “continuity of care” waiver, which would extend her previous in-network coverage for the treatment of an ongoing condition for the October hospital visit and surgery. If it doesn’t work out, she could owe thousands of dollars. “I don’t know where it stands,” Azzopardi said.

On a larger level, the severed contract between a hospital system and health insurer reflects tensions that have been growing nationally this year. In the past, even when contract negotiations became publicly antagonistic, they typically would be resolved before the deadline for termination.

Now health care consultants and industry officials say an increasing number of contracts end without a deal. Even if they are eventually resolved, those terminations throw tens of thousands of patients into the difficult position of choosing between much higher out-of-pocket costs or leaving a trusted physician and hospital.

The Wellstar vs. UnitedHealthcare situation — and an even bigger dispute looming in metro Atlanta involving Anthem Blue Cross and Blue Shield — come at a tricky time, during open enrollment season when many employers have already picked their insurance offerings and many consumers must choose their health plan.

“We are seeing more insurers terminate contracts without a deal, and this is both a national and local trend,” said Beth Spoto, a Georgia-based health care consultant with Spoto & Associates. From the insurers’ point of view, she said, it’s a hardball tactic to lower payment rates to medical providers for services.

“Health systems are getting quite large, so you are dealing with hundreds of millions of dollars,” she said. “The fighting is getting pretty tough.”

Recent contract terminations involving big insurers include UnitedHealthcare vs. Montefiore Health System in New York, and Anthem vs. Dignity Health in California. Each conflict was eventually resolved, though Montefiore took several months to settle.

Hospitals are reporting higher tensions in negotiations with health insurers, said Molly Smith, an American Hospital Association vice president. She said contract talks often are not conducted by local executives of the insurer, which might allow for more collaboration, but are directed instead by company headquarters.

Just in the Atlanta area, other out-of-network situations involving insurance heavyweights UnitedHealthcare and Anthem have occurred in the past couple of years. Northside Hospital’s Gwinnett County facilities were out of network for UnitedHealthcare members for five months, while Northeast Georgia Health System in Gainesville left Anthem’s lineup for three months.

In the most recent dispute, Wellstar said it wants UHC to pay reimbursements similar to those it gets from other insurers. UnitedHealthcare, based in Minnesota, counters that Wellstar wants “egregious” rate hikes that the insurer said would amount to 37% over three years.

“Both sides said the other is just out for money,” Azzopardi said. The impasse, she said, “is cruel to the patients who have done nothing wrong.”

The open enrollment quandary has Emilie Cousineau of Smyrna, Georgia, wondering whether to stay with UnitedHealthcare or switch to Anthem, which she said would cost her more for the upcoming benefits year in her employer plan.

Cousineau canceled a Wellstar well-check appointment recently because suddenly it was out of network. “Right now, it’s an inconvenience.” But her doctor as well as her kids’ pediatrician are Wellstar physicians. “I’m picky about my health care,” she said.

Uncertainty over covid and rising hospital labor costs are fueling the disruptions, consultants said.

Health insurers recorded sky-high profits last year as people avoided medical care because of fears about covid. This year, profits have been lower but still healthy. For hospitals, the pandemic brought mixed results. Some richer, bigger health systems racked up huge surpluses, helped by covid relief funds, while many safety-net and rural hospitals fought hard to break even.

Cole Manbeck, a spokesperson for UnitedHealthcare, said affordability of health care is of prime importance to consumers and employers. They expect the insurer to help contain costs, which requires maintaining fair and competitive agreements with hospitals and doctors in its network, he said.

Insurers also point out that health care systems have enhanced their bargaining clout by acquiring additional hospitals and doctor practices. The tough negotiations extend to physician group contracts, said Dave Smith with the health care consulting firm Kearny Street Management. Insurers, he said, “are trying to drive health care costs down, and are doing it on the backs of physicians and hospitals.”

Factoring into the fray are payment delays involving insurers Anthem and UnitedHealthcare. Hospitals are dealing with a spike in retroactive claim denials by UnitedHealthcare for emergency department care, the AHA’s Smith said.

KHN also recently reported that Anthem Blue Cross is behind on billions of dollars in payments owed to hospitals and doctors because of onerous new reimbursement rules, computer problems and mishandled claims, according to hospital officials in multiple states.

Tom Mee, CEO of North Country Healthcare in New Hampshire, said the outstanding claims owed to his system by Anthem rose $250,000 in one quarter to reach $1 million.

Indianapolis-based Anthem said the contract rifts and the claims issue are not related. Both it and UnitedHealthcare noted that the large majority of contracts are renewed without public attention.

Employers, meanwhile, don’t like these network disruptions, said Ash Shehata, a health care consultant with KPMG. But, he added, employers also don’t want to subsidize the rate increases.

“When times are good, and everybody is doing well, generally you don’t see these negotiation issues,” he said. “As long as the environment remains unpredictable, we’ll see some unpredictable negotiations.”

Contract terminations harm hospitals more than insurers, said Nathan Kaufman of Kaufman Strategic Advisors. For example, UnitedHealthcare and Anthem, which operate in several states, “can take a hit in one state,” he said, because they’re diversified and insurers still receive premium payments for members after a contract with a hospital lapses.

“On day one, the hospitals start feeling increased financial stress,” Kaufman said. “They experience this financial jolt.”

The Atlanta market is facing another such contract disruption. Anthem has alerted consumers that Northside Hospital and its facilities may not be part of its network come Jan. 1. While the Wellstar vs. UnitedHealthcare tug-of-war involves an estimated 80,000 consumers, the Northside contract could affect four or five times that many, according to Northside officials.

“Anthem’s timing is very unfavorable to our patients,” said Lee Echols, a Northside spokesperson. “It’s hard to understand. We’re still in a pandemic, and this is the open enrollment period for health care policyholders. Many people are returning to their physicians and hospitals for deferred care, and Anthem’s threats make that process really challenging.”

But Anthem spokesperson Christina Gaines said that the company is fighting to curb health care costs, and that Northside is one of the most expensive systems in Georgia.

The showdown has consumers such as Carol Lander of Sandy Springs, Georgia, concerned and confused.

She has been an Anthem member for years and has used nearby Northside facilities and doctors. She’s now shopping for other plans to see if they include Northside in their networks. One insurance plan has her doctor but not her sons’ physician.

“It’s so frustrating,” said Lander. “This is a huge deal in this area.”

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The number and complexity of school quarantine policies have left many parents with the impression there is little rhyme or reason in quarantining one kid and not a classmate.

This article was published on Tuesday, November 16, 2021 in Kaiser Health News.

By Sheila Mulrooney Eldred

At this point in the pandemic, most parents are familiar with “covid notification” letters. But the letters’ instruction on whether your kid must quarantine or not varies wildly from school to school.

In Minneapolis, students exposed to covid-19 at school are supposed to quarantine for 10 days. In the suburban Anoka-Hennepin school district, a single exposure does not trigger contact tracing or quarantining.

In Andover, Kansas, schools follow quarantine protocols set by county health departments. With students from different counties attending the same school, those sitting next to each other in classrooms could be quarantined based on two sets of rules.

In Anchorage and many schools in Texas, close contacts of classmates who test positive for covid are given the option to stay in class or to quarantine. In suburban Chicago, siblings of students with any symptom of covid are required to quarantine until their sibling tests negative.

The number and complexity of school quarantine policies — in Fort Mill, South Carolina, eight pages of guidance directs students when to quarantine — have left many parents with the impression there is little rhyme or reason in quarantining one kid and not a classmate. Sometimes rules seem to vary within families: Christina Kennedy, a teacher in Bend, Oregon, got a call when her son was exposed to a positive case in August, and he was required to quarantine. But when her daughter was a close contact to a positive case, no call ever came.

“Unfortunately, we have a natural experiment going on across the country when it comes to schools reopening, particularly regarding quarantining,” said Dr. Leana Wen, a public health professor at George Washington University. “Some of it is understandable, but there is a piecemeal approach for certain when it comes to various approaches.”

The Centers for Disease Control and Prevention’s guidance calls for unvaccinated kids exposed to someone who tests positive for covid to quarantine for a length of time determined locally. But a state or county or school district’s decision to impose a quarantine requirement is haphazard. An informal coalition that advocates for in-person learning, Ed300, found that 31 states are not automatically quarantining students from close-contact exposures.

“What we have learned from this pandemic is that when there is not a directive, school districts will behave autonomously and you’ll get this kind of outcome — good, bad or otherwise,” said David Law, superintendent of Minnesota’s Anoka-Hennepin School District.

Schools in his state act independently, Law noted.

That’s true in many other areas too. “Principals and county health officials have a lot of leeway,” said Leslie Bienen, a parent involved with Ed300 and a faculty member at the Oregon Health & Science University-Portland State University School of Public Health.

“The quarantine could be seven or 14 days,” Bienen said, and local officials have a lot of say in determining who qualifies as a close contact — defined by the CDC as having been within 6 feet of someone for a cumulative total of at least 15 minutes over a 24-hour period. But the agency has also recommended that schools maintain at least 3 feet of distance between students.

Local control isn’t necessarily a bad thing — schools should be the ones setting their rules, Wen said — but that’s why things can look so different from one school to the next, no matter how close they are in proximity.

Kennedy, the Bend, Oregon, teacher, works at a private school while her husband teaches at a public school her kids attend.

“The private school is much more prone to shutting down entire classrooms than the public school,” Kennedy said. “I know of three entire classrooms shut down since September at my private school” while zero have been shuttered in the public system.

Districts in the same county, under the purview of the same public health officials, are handling it differently, she pointed out. “Nothing is consistent. They say it’s all based on science, but we’re not allowed to question or point out anything. Why is it this way here and this way there? It’s super frustrating as a parent and as a teacher,” Kennedy said.

Another frequent complaint: Policies differ depending on whether students are there for school or for after-school activities or whether it is a community or sporting event. “What really irritates our community is that you can show up for a community event at the school or spend four hours at a sporting event and no one gets quarantined, but you can sit next to someone for 40 minutes during the school day and be out of school for 10 days,” Law said.

The confusion has left many parents wondering whether policymakers have done their homework.

Jessica Butler Bell, vice president of communications for Webster Elementary’s PTA in California’s Santa Monica-Malibu Unified School District, said parents are asking, “Are we really following the science? Or are we being too careful? It has to be rooted in logic, and I think people are going, ‘Have you thought this through?’”

Bienen co-authored an opinion piece in The Wall Street Journal titled “It’s Madness to Quarantine Schoolchildren,” citing research showing that only a small percentage of students quarantined ended up testing positive for covid as a result of the school-based contact. The group also says data from Portland Public Schools shows that students who attend Title I schools — those that receive special federal funding because they serve large numbers of low-income families — are more likely to be quarantined.

“Kids with means go on vacation or to their grandparents when they’re quarantined,” Kennedy noted. “That’s great for them, but what about kids who don’t have parents at home? They’re sitting at home with no learning, no food, no services. It exacerbates the inequities.”

But parents get equally upset when rules are lacking: Wen said she’s heard of parents doing their own informal contact tracing when they think their schools aren’t doing a thorough job.

The complicated policies have other repercussions. Some parents grow reluctant to test their kids, Kennedy said, for fear that a positive test will force them out of school or activities. And at some schools, she added, teachers delay giving out seating charts to school nurses or other public health officials for contact tracing, knowing that kids may have to quarantine after the information is shared.

Some schools are piloting a possible solution: replacing quarantines with a “test-to-stay” policy. Under such a policy, any student deemed a close contact would be able to take a rapid test and show a negative result to stay in school and avoid quarantine.

CDC Director Rochelle Walensky recently noted that “we are working with states to evaluate a test-to-stay policy as a promising potential new strategy for schools. And we anticipate that there will be guidance forthcoming.”

Wen said she is optimistic the policy could help. “It’s a way to prevent kids from being out of school.”

In Santa Monica-Malibu, one frustration Butler Bell hears from parents is that there’s no plan for ending quarantines and other layers of protection.

Parents often feel their concerns are not being considered, Kennedy said. “If [decision-makers] spent one hour inside an actual classroom, they would make different decisions,” she said.