Account surprises: what you need to know about health insurance and treatment COVID-19

From the beginning of the pandemic COVID-19 providers faced a number of problems and had to react quickly to changes in laws and regulations affecting their activities. One of these changes are restrictions on so-called medical “invoice surprises” for patients with coronavirus infection, says JDSupra.

Счета-сюрпризы: что нужно знать о медстраховке и лечении COVID-19

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Patients with private insurance are personal expenses (also known as “cost-sharing” or cost-sharing) on health care, which may include deductibles, copayments or co-insurance. When the patient seeks medical assistance from a supplier with which his insurer has no contract (that is, not within the network), the patient may receive a bill from a vendor for payment of the difference between the total cost of services charged by the provider, and the amount paid by the insurer to the service provider. This practice is often called the “billing balance” or “invoice surprise”.

As Federal legislation (including relevant recommendations of the Federal Agency) and state laws affect how (or when) providers can achieve separation c patients the cost of testing and other services related to COVID-19.

Can the hospital to the patient means the split of expenses in case of testing and services related COVID-19, depends on whether the test or service diagnostic (is this a screening for coronavirus), or therapeutic (associated with treatment COVID-19). Please note that providers and health plans must not put patients “invoice surprises” in any case.

Diagnostic services associated with coronavirus

For certain services, granted March 18, 2020 or after that date and continued in an emergency, the Law on response to coronavirus disease families (FFCRA) requires insurers offering group and individual insurance, to cover qualified items and services provided during the visit about COVID-19, without any split of expenses (including deductibles, copayments and co-insurance). Skilled services include those offered during the visit that led to a test for the coronavirus when these services relate to the provision of the test or to evaluate whether a test (e.g. blood test, test flu and the like). This includes services provided in provider’s office (in person or via telegraphone), in the centre or the emergency Department.

Simply put, FFCRA requires that insurers have waived cost-sharing for testing for the coronavirus and the corresponding medical visit. However, this requirement does not apply to treatment. The suppliers receiving funds under the law CARES, no need to send “account balances” none of the patients receiving treatment from COVID-19.

Treatment COVID-19

Service providers can obtain the amount from the separated costs for other services related to COVID-19 (e.g., a visit to the emergency Department or hospitalization after the person was diagnosed COVID-19). However, recipients of funds in accordance with the Law CARES can ask the patient only the amount of separated costs at the network level, even if the provider is outside the network against the insurer of the patient.

Conditions CARES for recipients of funds require providers to recipients identified that in all cases assistance related to the alleged or actual event COVID-19, they will not require personal expenses of the patient for an amount greater than that which the patient would have to pay inside insurance network. In some States (e.g., Ohio), health insurance Corporation which provides insurance coverage, must provide coverage for emergency services outside the network without issuing “billing surprises.”

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

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