In 2020 Congress passed two laws to protect consumers from COVID-19 charges. So you might think you don’t need to worry about COVID-19 surprise bills. You would be wrong.
Rather than helping patients, some emergency rooms and doctors used the laws to enrich themselves. They overcharged insurance companies and consumers. Here are just two examples:
Lenox Hill in New York has repeatedly charged insurance companies about 30 times the typical cost of tests. That works out to over $3,000 per test.
A Connecticut physician ran a testing site in Bedford, NY. He not only overcharged for COVID-19 tests, he also charged for many unnecessary services. One patient’s charges included $6,816 for four COVID-19 tests, several other respiratory-related tests, and $480 for a call giving her the test results. The patient’s portion of the bill was $1,944.
Here’s what you need to know about the laws and what to do if you get a COVID-19 surprise bill.
Protection from COVID-19 Surprise Bills
The Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act protect consumers from certain COVID-19 charges. The FFCRA made COVID-19 tests free for most consumers. The protection lasts from March 18, 2020 through the COVID-19 public health emergency (PHE).
The Department of Health and Human Services sets the PHE period. It’s currently due to end on April 21, 2021. However, the Biden administration has indicated it’s likely to remain in effect through 2021.
The (CARES) Act became effective March 27, 2020. It required private plans to fully cover out-of-network COVID-19 tests.
Let’s take a closer look at the laws to understand what they do and do not cover.
Tests
FFCRA required almost all public and private insurance plans to cover COVID-19 tests at no cost to the patient. This requirement also extended to Medicare and Medicaid. However, the test has to be “medically appropriate.” That means you need to get a doctor or medical provider to approve the test.
You’ll note that I said this coverage applied to “almost all” plans. The law excluded short-term or limited duration plans. In other words, your insurance wouldn’t pay for the test.
The CARES Act included these additional provisions:
- Out-of-network providers would be reimbursed for COVID-19 tests up to the cash price posted on the provider’s public website.
- The Act didn’t say what the reimbursement amount would be if the price was not posted online.
- Out-of-network providers can bill patients directly for COVID-19 tests.
You may be asking, “What about treatment?” Neither FFCRA nor CARES addressed treatment costs. But several insurance companies offered their consumers some relief.
Treatment
The amount of financial relief you receive for COVID-19 treatment costs depends on who your insurance carrier is. Many private health insurance plans waived out-of-pocket costs for their members. Those are the amounts you pay for deductibles, coinsurance (a percentage of the charges) or copays (a flat dollar amount).
Those waivers were originally in place through 2020. But many have been extended. Use this website to find your insurance company’s current benefits. You can call your insurance company if you have a specific question or don’t see the information you’re looking for.
Medicare covers all medically necessary hospitalizations. You’ll be responsible for the plan’s copays. But Medicare will continue to approve your hospital stay if you would have been discharged, but need to remain hospitalized under quarantine.
If you have a Medicare Advantage plan, check with your insurance provider. Some, but not all, were waiving or reducing patient’s costs for COVID-19 treatment.
If You Get a COVID-19 Surprise Bill
Here are four things to do if you receive an incorrect bill or charges for a COVID-19 test or treatment:
- Get an itemized bill from the provider. Look for any duplicate charges or charges for services you didn’t receive.
- Your diagnosis code will likely determine whether or not you receive the savings. You probably didn’t get the savings if COVID-19 was not the diagnosis code. This will most likely happen if you were treated after being sent home from the hospital or some period of time has passed since your original diagnosis. This is particularly true for “long-haulers” — people who experience a wide variety of symptoms months after the original COVID-19 diagnosis.
- The good news, if you want to call it that, is that the National Institutes of Health (NIH) has proposed a name for the long-haulers’ condition: post-acute sequelae of SARS-CoV-2 infection. Look for this diagnosis or a related one if you’re a long-hauler.
- Carefully review your Explanation of Benefits (EOB). The EOB lists what your insurance company was charged for the services you received, how much they paid, amounts they will not pay and why, and how much you will owe.
- If you see charges for services you didn’t receive or amounts that seem unreasonably high (even in today’s world of incredibly expensive medical care), call your insurance company. Why? Because if your insurer paid the bill, the excess charges will likely be passed on to you in higher premiums.
- Ask a medical billing advocate to review your bills for accuracy. If there are incorrect charges, she can work directly with the provider or insurance company on your behalf.
Now you know how the laws protect you. Don’t be a victim of COVID-19 surprise bills. Take the actions you need to not overpay for COVID-19 tests and treatment.