While there has been a lot of coverage regarding the almost universal agreement by insurance companies to cover the cost of being tested for COVID-19, not much coverage has been published of the financial (medical) aftermath. What happens if you are positive? What happens if you wind up in the hospital? What happens if you find yourself on a ventilator and hospitalized? What about those bills? What if there are extensive complications?
According to the Kaiser Family Foundation, recent data suggests that patients who go to intensive care for treatment of COVID-19 stay there for an average of twenty days.
Last week, a study released by America’s Health Insurance Plans shared that their research shows that the average cost to treat a hospitalized COVID-19 patient is $30,000. Are you ready to pay your share of that bill? Will you be responsible for that bill?
What Might Your Insurance Company Cover?
HealthLink Advocates did a little research to see what happens with individual insurance companies in the aftermath of treatment. United Health Group, via a May 7, 2020 release states, “We are waiving cost-sharing for COVID-19 testing and the testing-related visit.” What happens past the testing-related visit?
Aetna updated their COVID-19 testing and treatment policy on May 13, 2020, stating, “Aetna will waive member cost-sharing for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19 through September 30, 2020”. For their older, Medicare aged insured, Aetna will cover the cost of the hospital stay for all Medicare Advantage members admitted March 25, 2020, through September 30, 2020.
Oscar Health, a widely subscribed healthcare program local to the New York City area has waived the cost of testing and the visit for both in-network and out-of-network facilities. Through May 31, 2020, they are waiving the cost of treatment related to COVID-19, as long as you are in-network. If you go out-of-network, costs will be waived but prior authorization must be obtained.
Horizon Blue Cross, which widely covers many private residents and State of New Jersey employees (State Health Benefits Program – SHBP) has tried to eliminate the barrier of those shunning treatment by announcing all cost-sharing obligations to include covered benefits associated with COVID-19 treatment. The policy is retroactive to March 1, 2020, and extends, at least for now, until June 30, 2020.
Be Wise and Informed or Else
All of this is great support, however, be careful of the disclaimers. Are you in-network? Did your provider agree that you needed a COVID-19 test? Did you go to an “approved” center? Did you receive an “approved treatment”?
Many of those afflicted with COVID-19 were treated with the drug, Remdesivir. Remdesivir has shown promise in stopping the virus from replicating inside cells and was approved for emergency use by the FDA in treating COVID-19 on May 1, 2020. Historically, once the FDA approves the usage of a drug, insurance companies will allow coverage in the billing schedules. In the last week, further research within ongoing trials will add a powerful anti-inflammatory drug (believed to calm down an inflamed immune system) to the Remdesivir cocktail for a one-two punch. Will that be covered?
Moving forward, there are a lot of questions regarding the costs associated with this drug. Gilead, the manufacturer of Remdesivir, committed to supplying U.S. hospitals with approximately 940,000 vials of the drug - thought to be enough to treat at least 130,000 patients to fight the pandemic. Published accounts have put the price for each course of treatment at $4,460.00 per patient. Currently, the first 130,000 patients to need the drug will receive it for free, as it has been donated by Gilead. What happens to patient 130,001? Each and every patient needs to stay on top of this and become familiar with the insurance portal of their particular plan. That will be the most convenient spot to find information needed when it comes to figuring out the financial responsibilities here. There are many research trials in progress – historically, only those trials reviewed and subsequently approved by the FDA for distribution have any chance of being covered by mainstream insurance carriers.
While we are relieved to see so much support for the financial medical cost fallout to individuals after recovery from COVID-19, it is clear to us that this is a very fluid situation. Not every health insurance company has published its protocol moving forward. Not every health insurance company has been clear about what happens after the test is positive.
How to Proceed & Surprise Bills
Our best advice is to wait this one out. If you received a COVID-19 test and later a bill from a provider, hold off. Wait for the second bill…and then be sure to check your EOB (Explanation of Benefits) before making any payment. Chances are that you will not be responsible for any of this. Some companies have even spoken about waiving the application of the deductible and coinsurance for these costs.
Additionally, be on the look-out for “balance-billing”. This is a phenomenon where a provider, treating you in a hospital that is in-network with your insurance company, is out-of-network. Confused? Of course you are…..it happens all the time, and while there has been a tremendous movement on to address this countrywide, Congress has not focused enough on this issue to act with comprehensive protections.
Balance Billing (sometimes referred to as “Surprise billing”) will be a big part of the financial (medical) discussion that we first mentioned early in this blog. Early on in the first days of the pandemic, a limited number of labs were available exclusively “in-network” and so the back-up was handled by a lab or pathologist that might not have been in the patient’s insurance plan. In other words, “Out-of-network”. While the “Families First Coronavirus Response Act” requires insurance to cover these services, patients requiring additional evaluations by specialists (pulmonology and/or infectious disease are common) may be blindsided by additional balance billing charges.
For those of you not aware, providers who have accepted funds through the CARES Act Provider Relief Fund are prohibited from sending any balance bill to patients who underwent COVID-19 related treatment.
One other area of concern covers the Emergency Departments of hospitals all over the country. Hospitals were reaching out where they could for staffing help – not all are vetted to make sure that they are in your particular insurance network. A crisis with billing is expected as patients all over the country are hit with these surprise bills. Generally, those patients covered with Government programs (Medicare, Medicaid, VA, etc.) are protected from balance billing. Some consumers are covered by balance billing laws enacted in their states (New York and New Jersey have both enacted balance billing laws).
The medical debt incurred by this pandemic has put a lot of pressure on Congress to finally create a nationwide standard dealing with balance billing. Maybe this will give them the push they needed.
For you, the individual patient, you need to be your own advocate if you have incurred COVID-19 bills. Either call for help (Healthlink is always an option) or push back yourself! Stand your ground and make sure that you are not paying for something you were either covered for or not responsible for.
Be aware….many providers will send the bill. If you pay for it, then you will have helped to keep the practice of “surprise billing” alive! So, so many (we see it here at Healthlink over and over again) patients make the assumption that the balance is theirs to pay. Not always! Be proactive. Make sure that you are not paying for something you need not pay for and keep on top of the changing situation for your individual insurance company as a result of the pandemic. As we mentioned earlier, things are very fluid now. Things will change, and it will be up to you to make sure that you are aware of your responsibilities when it comes to your medical bills, coverage, and COVID-19.