Surprise Accounts: What You Need to Know About COVID-19 Health Insurance and Treatment - ForumDaily
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Surprise Accounts: What You Need to Know About COVID-19 Medical Insurance and Treatment

Since the onset of the COVID-19 pandemic, healthcare providers have faced a variety of challenges and have had to quickly respond to changes in laws and regulations affecting their operations. One of these changes is restrictions on so-called medical “surprise bills” for patients with coronavirus infection, writes Jdsupra.

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Patients with private insurance have out-of-pocket costs (also known as cost-sharing) for health care, which may include deductibles, copayments, or coinsurance. When a patient seeks care from a provider with whom their insurer does not have a contract (that is, out of network), the patient may receive a bill from the provider for the difference between the total cost of services charged by the provider and the amount paid by the insurer to the provider. This practice is often called "balance billing" or "surprise billing."

Both federal law (including relevant federal agency recommendations) and state laws affect how (or when) providers can ensure that patients share the cost of testing and other services related to COVID-19.

Whether a hospital can receive cost-sharing funds from a patient for tests and services related to COVID-19 depends on whether the test or service is diagnostic (related to testing for coronavirus) or therapeutic (related to treatment for COVID-19) -XNUMX). Please note that providers and health plans should not provide “surprise” bills to patients in any case.

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Coronavirus Diagnostic Services

For certain services provided on or after March 18, 2020, and continuing in an emergency, the Family Coronavirus Disease Response Act (FFCRA) requires insurers offering group and individual insurance to cover qualified items and services provided during their visit to Concerning COVID-19, without any divided costs (including deductibles, co-payments and co-insurance). Qualified services include those provided during the visit that led to the coronavirus test, when these services are related to the provision of the test or to assess the need for the test (for example, a blood test, a flu test and the like). This includes services provided at the provider’s office (in person or through telehealth), at the center or emergency department.

Simply put, the FFCRA requires insurers to waive cost sharing for coronavirus testing and related medical visits. However, this requirement does not apply to treatment. However, providers accepting CARES Act funds are not required to send “balance bills” to any patient being treated for COVID-19.

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COVID-19 Treatment

Service providers may receive amounts from shared costs for other services related to COVID-19 (for example, visiting an emergency department or hospitalization after a person has been diagnosed with COVID-19). However, recipients of funds under the CARES Act may request from patients only the amount of shared costs at the network level, even if the provider is offline with the patient insurer.

The CARES Recipient Conditions require recipient providers to certify that, in all cases of care related to a suspected or actual case of COVID-19, they will not charge the patient out-of-pocket expenses in excess of what the patient would be required to pay internally. networks. In some states (such as Ohio), health insurance corporations providing coverage must provide coverage for out-of-network emergency services without issuing “surprise” bills.

Finally, it is worth noting that, although this is not required by law, several of the country's largest insurers, including Cigna and Humana, voluntarily refuse any cost-sharing for coronavirus infection for fully insured patients and / or receiving Medicare Advantage products, such as inpatients sick.

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