A potentially welcome relief for many current and possible future patients included in CARES Act legislation is prohibition of what's called "surprise billing," wherein insurers or health practices charge patients the difference between a covered procedure and the actual cost. I can tell you that every single member of my nuclear family has had this happen to us, and sometimes the amount charged can be devastating financially to patients.
There may be long-term questions that come from this part of the law, like whether this kind of billing will be banned in general in the future, or if things will go back to typical practice once the immediate threat is gone. A few pieces, below. if you've been charged an unexpected amount like this for COVID19 testing, reach out to XXXXX to report it.
Explaining the fees and billing changes in the legislation, below.
Kaiser Health News: In Fine Print, HHS Appears To Ban All Surprise Billing During The Pandemic
This article led the Health and Human Services Department (HHS) to issue a clarification on those initial guidelines, but not completely answer questions about it. See below for continuing issues.
Kaiser Family Foundation: New Questions on COVID-19 Funding for Hospitals and Other Providers
"HHS changed the Terms and Conditions so that this provision applies only to a “presumptive” or actual case of COVID-19 rather than a “possible” or actual case of COVID-19. However, a “presumptive case” is not defined. Will HHS issue any guidance on this issue? Will a patient with a suspected case of COVID-19 who subsequently tests negative qualify as a “presumptive” case?
"Under the Terms and Conditions, providers cannot collect cost sharing in excess of what a patient would have to pay for in-network care, but providers are not required to bill insurers for out-of-network care directly. How will providers know each patient’s in-network cost sharing amount if the provider is not required to bill insurers directly?
"Can out-of-network providers bill patients who are covered by HMOs or other closed network plans that do not provide any coverage for non-emergency out-of-network claims other than COVID-19 testing?
"How will patients be notified about this new protection and how to file a complaint if their provider does not comply?"