Published on December 22, 2020
Since the COVID-19 pandemic began, Americans have been receiving mixed messages. Congress says the government will ensure testing is free and care doesn’t result in surprise coronavirus hospital bills, but patients are still being hit with surprise charges — sometimes huge bills that they can’t pay.
Relief packages passed by Congress early in the year do dictate some things about COVID-19 testing and coronavirus hospital bills, but that doesn’t mean they’re easy to understand. And while insurance companies are required by law to follow certain billing practices for COVID-19 testing, they don’t always do so.
The bottom line is that COVID-19 medical billing regulations are complex and poorly enforced, and your best advocate is yourself.
All Americans should know their rights, and what to do about surprise bills if they get COVID-19. Here’s what you need to know.
First, let’s take a trip back in history — to 2019, when Congress was debating how to protect Americans from receiving large, surprise bills for medical treatments that aren’t covered by their insurance.
Legislation to put an end to surprise hospital bills was popular among the public, had bipartisan support, and was backed by the White House. But as Congress was preparing to pass a law, advertisements against it started flooding markets. The New York Times discovered that they were funded by private-equity firms that own outsourced medical services, like blood-testing laboratories, ambulance services, and doctor staffing agencies. As we’ll talk about more below, those kinds of outsourced medical services are responsible for many surprise bills patients receive.
After all the ads came out, Congressional committee chairs ended up postponing the issue. Just months later, the pandemic struck with no laws in place to help protect Americans from surprise medical bills.
Finally, in December 2020, Congress passed legislation banning surprise bills arising from unexpected out-of-network care.
Early in the pandemic, Congress passed two major pieces of coronavirus aid: the Families First Coronavirus Response Act (FFCRA) on March 18, and the Coronavirus Aid, Relief, and Economic Security (CARES) Act on March 27.
These are both extremely complex pieces of legislation that include a lot of provisions (some that aren’t even related to the pandemic), so we’ll only do an overview here that covers the points that are most relevant to most Americans.
The FRCCA made testing free for most insured Americans. It also laid out provisions saying that insurers needed to cover associated medical costs without cost sharing. That means, in theory, Americans with qualifying health insurance should have to pay nothing for a COVID-19 test. This only applies to employer-provided insurance and ACA-compliant private insurance plans.
The FRCCA also established a billion-dollar federal fund to cover testing for uninsured Americans. Healthcare providers who give tests to uninsured people can bill the Health Resources and Services Administration for reimbursement.
The CARES Act went a step further by mandating that qualifying insurers must cover the cost of out-of-network testing. This was an aim to make testing faster and easier amid shortages of tests and supplies across the country.
The two laws do not provide any provisions or relief to help pay for COVID-19 treatment for Americans who are infected and become sick.
Coronavirus relief laws say that if you have a qualifying health insurance plan, you should not have to pay anything out-of-pocket for COVID-19 testing (so none of the co-pays or deductibles that would typically apply to care). The law says that charges for other services necessary to testing should also be covered without cost sharing, but it doesn’t define what those are, which is one of the reasons people are still getting surprise bills for COVID testing. Doctor visit fees, facility fees, flu tests done alongside the COVID-19 test, and other costs may not be covered. The law is too vague to know for sure, so many insurance companies are not covering these kinds of costs.
And while relief laws don’t offer any help with the cost of coronavirus hospital bills for Americans who require treatment, a number of insurance companies have responded to public pressure and said that they’ll cover in-network treatment without cost sharing for their customers. This will depend on the company and the plan, so look into your own insurance to see what’s covered for you.
If you don’t have health insurance, you should still be able to get free testing, either by going to a public testing site, or by asking your doctor to bill the government under the FRCCA.
Coronavirus relief packages provided financial aid to hospitals, medical centers, and providers on the condition that they promise not to stick patients with large surprise bills.
As we all know, things didn’t work out exactly as planned.
There’s the problem we mentioned above, which is that the law states that the cost of services necessary for getting a COVID test must be covered in full by insurers, but doesn’t specify what kinds of services count as “necessary.” A common scenario is that a patient gets a COVID-19 test at a drive-through testing site, and is charged a “facility fee.” Is that illegal? We don’t really know.
The strain that the pandemic has put on our healthcare system only further complicates things. Some patients have reported seeking treatment at in-network hospitals, then getting billed for out-of-network services that the hospital outsourced because of capacity issues. In some cases, people are being transferred to out-of-network hospitals and treated by out-of-network doctors because of hospital overcrowding. That can result in a huge surprise bill. The New York Times profiled a woman who was airlifted to a different hospital for treatment that saved her life — and then received a $52,000 bill for the air ambulance, which was out-of-network for her.
And then there are simple cases of insurers not following the law. It’s unfortunately common for people to receive bills after their COVID-19 tests are processed at out-of-network labs, even though the CARES Act says insurers need to cover that cost in full.
Unfortunately, it might be impossible to completely avoid them. But there are still steps you can take to reduce the likelihood of getting stuck with a surprise bill for COVID testing or treatment.
While the spirit of the law is that testing should be free for all Americans, you can reduce the likelihood of surprise charges by choosing the right testing facility. If possible, get tested at a public testing site. These are government-funded facilities that are more likely to know and follow the law and not charge people for tests.
If a public testing site isn’t an option, see your primary care provider, or go to another location that you know is covered by your insurance. Even though the law says insurance companies need to cover out-of-network testing, that isn’t always what happens, and it’s easier to avoid a surprise bill than to dispute one later.
A big reason many Americans are getting surprise bills is because of tacked-on costs and services that insurance companies deem to be not necessary to getting a COVID-19 test. For example, if your doctor takes a nose swab to test for both COVID-19 and the flu, you might later get a surprise bill for the flu test.
To avoid this, simply say to your doctor, “I understand I’m getting a COVID-19 test today. Will you be billing me for any other tests or services?” If they say yes, you can ask to skip other tests.
If you go to your regular doctor for a COVID-19 test and receive a bill for a co-pay, the medical coding for your visit might be to blame. For example, if your doctor has your test processed at an outside lab that does its own billing, then your office visit might not appear to be related to a COVID test, according to your insurance company. In a case like this, you might need to ask your doctor to re-code your visit so it’s clear for insurance purposes that you were there for a covered COVID test.
Even though there’s a lot to wade through, one of your best protections against surprise bills is knowing your rights under coronavirus relief laws.
Know that insurers must cover the cost of COVID-19 tests without any cost to you. If you’re charged a co-pay or deductible, you can fight it.
Know that insurers also must cover the cost of any services that are necessary as part of getting a COVID-19 test, so if you get a surprise bill with charges for office or facility fees, doctor visit fees, or other tests, talk to your doctor and see if they’ll help you by telling your insurer that those services were necessary as part of your COVID testing visit.
And if you receive a bill for any services from out-of-network providers after getting a COVID test, know that the law says insurers have to cover those, too. You have grounds to dispute a bill if it violates your rights, but the first step is knowing when that’s happening.
Despite your best efforts, you might still receive a surprise bill for COVID testing or treatment. Don’t panic — you still have options. Here’s what you need to know.
It’s estimated that as many as 80 percent of hospital bills contain errors. You could very well be being overcharged (or charged for services, procedures, and treatment you didn’t receive). Before paying any hospital bill, check the itemized list of codes carefully and make sure all the charges are legitimate.
Part of the reason so many medical billion errors sneak through is that hospital bills are confusing. If your bill contains charges you don’t recognize or understand, call the hospital and ask for clarification. Ask what the service was, why it was performed, and whether it can be re-coded so your insurance will cover it.
Many people don’t know that you can negotiate with hospitals, doctors, medical providers, and even your insurance company.
So when you receive a surprise bill, start calling everyone who was involved in your care and asking what they can do to help you. It’s not likely that you’ll end up not having to pay anything, but it’s certainly possible to get many small reductions in bills for different services. Those can add up and save you a significant amount, especially on a big coronavirus hospital bill.
The coronavirus pandemic is still very new, and still a public health emergency that has hospitals, healthcare providers, insurance companies, and the government scrambling to get through. There’s likely to be fallout from this crisis that we can’t even predict yet.
So, if you’re comfortable, send your bills to news outlets and advocacy groups who are tracking COVID-related hospital bills. Those are the agencies who will work to hold the government, insurers, and healthcare providers responsible for taking care of their patients, and who will put pressure on those agencies to mitigate the financial fallout from the pandemic.
Here’s a good option: The New York Times coronavirus hospital bill database.
If you aren’t able to dispute your bills and need help paying them, there are many organizations that exist to help people with medical bills.
If you get a surprise medical bill and you can’t afford it, you’re better off not paying than doing something like putting it on a credit card or getting a payday loan. While not paying a medical bill can hurt your credit, hospital bills typically don’t carry interest. You should also call the hospital and try to defer payment temporarily or set up a payment plan that works for your budget.
If Congress had acted before the pandemic, surprise medical bills would be a thing of the past for Americans. But instead of passing legislation that would help patients, lawmakers gave in to special interest groups who were willing to spend money to maintain the status quo.
What can you do? Well, write to your congresspeople and tell them you want an end to surprise billing and other patient-first healthcare reform. You can also vote for candidates with healthcare platforms you’d like to see enacted, and support advocacy groups that are fighting for healthcare access and reform.
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