While people struggle with the life-threatening effects of COVID-19, the chaos of sky-high emergency room bills plays out in a way that is sadly familiar to anyone who has ever received a surprise medical bill:
Blanket statements when new policies or legislation are released make the changes sound like they will provide long-awaited relief, but the devil (and thus the surprise bill) is in the details.
For example, the Family First Coronavirus Response Act states patients will not be charged for COVID-19 testing, testing-related charges, or fees for determining the need for a test. “Testing-related charges” and “services used to determine the need for testing” leave a lot of room for hospitals to determine whether or not the services in question meet the Act’s requirements. Hospitals often interpret laws and regulations in the broadest sense to push costs on to insurers or patients. In turn, insurers protect themselves with policy language that states determining responsibility for such payment is between the hospital and the patient. In other words, it’s not their responsibility.
In addition, the changes made to many health insurance policies, like Humana’s and Cigna’s, do not apply to self-funded insurance plans. Self-funded employers are simply “encouraged to follow” the policies, but aren’t required to do so.
What are self-funded plans? The plans established by most large employers, who pay (or self-fund) insurance costs while insurance companies only administer the plans. A 2018 survey by the Kaiser Family Foundation found that 61% of employees with insurance are in plans that are “partially or fully self-insured.”
What Patients Need to Look For In Policy Plan Changes and New Laws
Whenever you talk to the billing department, your insurer, or employer about medical bills, take notes during the call including the name of the person you spoke with, date and time of the call. Read back your notes and ask if you have correctly understood the information given to you. That information will be important if you choose to appeal the bill.
If you would like help working through your medical bill issues, there are health care advocates specializing in insurance billing. The Alliance of Professional Health Advocates has a directory of advocates you can search by service. Type in medical billing and your zip code for advocates in your area. A Google search of “medical billing advocates” will also provide a list of possible services. Before signing up for assistance, be sure you are clear about the advocate’s fees and exactly what services are and are not included.