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Surprise Accounts: What You Need to Know About COVID-19 Medical Insurance and Treatment

Since the onset of the COVID-19 pandemic, healthcare providers have faced a range of challenges and have had to respond quickly to changes in laws and regulations affecting their operations. One such change is restrictions on so-called medical “surprise bills” for patients with coronavirus infection, writes Jdsupra.

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Patients with private insurance have a personal cost (also known as cost-sharing) for medical care, which may include deductibles, copayments, or co-insurance. When a patient seeks care from a provider with whom their insurer does not have a contract (i.e., not in the network), the patient may receive a bill from the provider to pay for the difference between the provider's total cost of services and the amount paid by the insurer to the provider. This practice is often referred to as "Balance Billing" or "Surprise Invoicing".

Both federal law (including relevant federal agency recommendations) and state laws affect how (or when) providers can ensure that patients share the cost of testing and other services related to COVID-19.

Whether a hospital can receive shared costs from a patient for tests and services related to COVID-19 depends on whether the test or service is diagnostic (related to coronavirus testing) or curative (related to COVID treatment) -nineteen). Please note that providers and health plans are not required to issue “surprise bills” to patients in any way.

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Coronavirus Diagnostic Services

For certain services provided on or after March 18, 2020, and continuing in an emergency, the Family Coronavirus Disease Response Act (FFCRA) requires insurers offering group and individual insurance to cover qualified items and services provided during their visit to Concerning COVID-19, without any divided costs (including deductibles, co-payments and co-insurance). Qualified services include those provided during the visit that led to the coronavirus test, when these services are related to the provision of the test or to assess the need for the test (for example, a blood test, a flu test and the like). This includes services provided at the provider’s office (in person or through telehealth), at the center or emergency department.

Simply put, the FFCRA requires insurers to waive the cost-sharing for coronavirus testing and the associated medical visit. However, this requirement does not apply to treatment. However, providers accepting CARES funds should not send “balances” to any patient undergoing treatment for COVID-19.

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COVID-19 Treatment

Service providers may receive amounts from shared costs for other services related to COVID-19 (for example, visiting an emergency department or hospitalization after a person has been diagnosed with COVID-19). However, recipients of funds under the CARES Act may request from patients only the amount of shared costs at the network level, even if the provider is offline with the patient insurer.

CARES conditions for recipients of funds require recipient providers to certify that in all cases of care associated with a suspected or actual COVID-19 event, they will not charge the patient with personal expenses in excess of what the patient would have to pay internally. networks. In some states (such as Ohio), health insurance corporations that provide coverage are required to provide coverage for out-of-network emergency services without billing.

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

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