Hospitals around the country are scared to send hundreds of thousands of invoices related to COVID-19 testing out. That is because Congress mandated there would be no costs for sufferers and no copays. But companies with health plans seem to think they’re exempt from the principles.
Vanderbilt University Medical Center in Nashville, Tennessee, fired up its labs, when studying kits were scarce. It nearly single-handedly took over testing in a lot of Tennessee. Even though the tests were assumed to be covered by insurance, other health programs did not even try to compete.
In late March, Congress passed the Families First Coronavirus Response Act two laws and the CARES Act, that stated that not only does testing have to be covered, but patients shouldn’t need to pay a dime. Yet VUMC has discovered that’s often not the case.
“As many as half of those patients possibly have some out-of-pocket [cost], possibly for the evaluations or for company services together with the test,” VUMC Chief Financial Officer Cecelia Moore said.
VUMC is holding bills for these patients back, Moore stated, rather than face a backlash of anger during the ordeal in surprise charging.
The issue boils down to an interpretation of whether the new national laws applies to health plans offered by larger employers. Those firms, which have at least a couple hundred workers, often use their own money to cover claims as a means to drive down costs. A survey by the Kaiser Family Foundation finds the majority of Americans with health coverage are in this kind of plan. (Kaiser Health News is an editorially independent application of the foundation.)
Thus the insurance company is merely managing the obligations , although BlueCross BlueShield of Tennessee might be on a worker’s insurance card. The promises are paid by the employer’s cash; it may not be clear to workers that they’re in a plan, and these plans are usually called self-insured or self-funded.
According to sources, a number of the companies with these programs are working as if they’re exempt from the new rules.
“In this instance, it looks like the law may have abandoned self-insured employers from certain elements,” said Mike Thompson, CEO of the National Alliance of Healthcare Purchaser Coalitions.
The National Alliance reflects companies with wellness plans that are self-funded. He said some are not currently waiving copays and other bills. Many are, he said, though sometimes bills for the COVID-19 test itself rather than to the test to rule out that the flu or the physician’s visit.
“A lot of these have chosen to pay a first-dollar foundation, but in various ways. They may or may not have included the related treatment components,” Thompson explained. He admits the distinction would be lost on individuals. “I understand why it is causing confusion”
Other associations representing health plans, such as the Business Group on Health, said their members are usually after law’s spirit.
Health policy experts do not see any room for interpretation.
“It doesn’t matter whether it is a self-funded plan or a fully insured plan, should you obtain it out of a small employer or a large company, if you get it on your own in the market,” explained Karen Pollitz, a senior man with KFF. “All private insurance must cover 100 percent of the price of COVID-19 testing”
Pollitz said she is miffed that companies are trying to assert otherwise.
It’s not just in Tennessee, and happening.
Duke Health at North Carolina affirms it is not billing claims related to testing or therapy, citing a lack of clarity in what the individual is responsible for paying. billing, UCSF Medical Center is also holding off Back in California, and UCLA Medical Center is currently pressing on on health programs to pay their role.
“UCLA Health does not bill COVID-19 patients for analyzing even if their health program erroneously doesn’t pay,” spokesperson Enrique Rivero stated in a written statement. “Our practice is to notify insurers of their mistake and ask they reprocess maintains consistent with CARES Act guidelines”
Cleveland Clinic and NYU Langone Health stated they won’t charge patients for any cost sharing for testing, even if that means they need to put up with the price tag.
The issue extends beyond medical centers. Envision Health, a firm that operates and staffs hundreds of emergency rooms across the nation, is holding rear 200,000 bills associated with COVID-19 testing because of confusion about coverage of cost sharing.
So, many would-be surprise invoices are waiting to be routed out. In billing because mid-March at Vanderbilt the center has held more than $ 6 million.
“I understand I am supposed to be shaking down everybody, but we are not right now,” explained Heather Dunn, VUMC’s vice president of revenue cycle solutions.
Given the disdain for surprise medical bills, she anticipates a backlash from exposed patients.
“My greatest fear is [for] patients who are currently suffering from this COVID virus or issues later or have lost their job. I’m reluctant to say,’Your insurance company has passed with this $50 copay.
The individual can be left to pay.
Dunn explained just because the tests should be free to patients does not mean they have no price tag and that she can not delay billing forever.