Surprise medical bills were a growing concern for consumers even before the appearance of the coronavirus, but the current health crisis is expected to exacerbate these worries. Congress can and should adopt a comprehensive solution to all surprise bills as soon as possible. However, even if Congress were to act immediately, the effective date for new comprehensive protections would necessarily be delayed to allow those protections to be fully implemented by the federal government.

This post identifies some of the unique circumstances in which patients might face a surprise bill because of coronavirus and summarizes some state approaches to protect consumers in these instances. Given the crisis (and a delay in comprehensive protections even if enacted), this post suggests a more immediate solution that Congress could adopt now and maintain until comprehensive protections are enacted and fully implemented.

Coronavirus Exacerbates Concerns About Surprise Medical Bills

Even before the outbreak, two-thirds of Americans were worried about being able to afford an unexpected medical bill, and millions face the risk of a bill from an out-of-network provider during an emergency, during surgery, and even during a stay at an in-network hospital. Unfortunately, in addition to its other stresses on access to health care, coronavirus is expected to increase the odds of receiving a surprise bill across all phases of testing and treatment. In 2018, nearly one in five Americans with pneumonia (a condition that is arguably similar to coronavirus) who were admitted to a hospital faced an out-of-network bill during their stay—a slightly higher rate than for other health conditions. Here are some of the unique ways that a patient could receive a surprise bill due to coronavirus-related testing and treatment.

First, although access to coronavirus testing is increasing, the labs able to perform the test remain limited, increasing the likelihood that a consumer will have their test performed at or read by an out-of-network lab or pathologist. The Families First Coronavirus Response Act requires insurers to cover—without cost sharing—any services or items provided during a medical visit that results in coronavirus testing or screening. But the new law does not prohibit balance billing by the provider that administered the test, meaning a patient might still face a surprise bill. Read more…

 

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