Coronavirus Diagnosis Could Lead To Surprise Medical Bills

Coronavirus Diagnosis Could Lead To Surprise Medical Bills
Some insurers are waiving all copayments and deductibles; others say they're waiving the cost of telemedicine visits.

So you’ve gotten the diagnosis: It’s COVID-19. And like hundreds of thousands of people worldwide, you recover. 

But what if that recovery involves medical treatment? Who pays the bill?

That depends. Some insurers are waiving all copayments and deductibles. Others say they’re waiving the cost of telemedicine visits. 

“A lot of these policies are being put out by companies individually. And since it’s individual, they can decide what their policy wants to look like,” said Emmarie Huetteman of Kaiser Health News. 

So the devil is in the details. And if you take a closer look at the statements from some insurers, you might see a line like this: Payments for treatment “from doctors in your plan’s network.”

Which could create a problem known as surprise medical billing. That’s when a patient goes to an in-network hospital but is treated by an out-of-network medical professional. 

“They're fearful of getting coronavirus, and they're fearful of getting screwed,” said Cynthia Fisher. 

Cynthia Fisher, the founder of Patient Rights Advocate, says she knows patients who have felt the sting of surprise medical billing. 

“My daughter had a friend who got COVID, went into the emergency room. He gets a surprise bill. Because the doctors in that emergency room, they do a check, they did a chest X ray. The radiologist is not in 'in network' and so they bill separately from the hospital,” said Fisher.

Incidents of surprise billing for COVID-19 treatment are popping up across the country. 

The last Congressional stimulus bill provided protections for surprise billing when it comes to COVID-19 testing but not treatment. Even that has its flaws. 

“They've said coronavirus testing is going to be free for everyone, doesn't matter if you're insured, whatnot, we’ll pay for it. That being said, there are cases that we're seeing already where there are patients who are noticing that the system has some loopholes. I'm even seeing cases of patients who are saying, hey, my insurance says they'll only pay for my coronavirus test if I have coronavirus. How am I supposed to tell?" noted Huetteman. 

Sen. Bill Cassidy, who is also a physician, told Newsy’s Alex Miller he wants to see measures to address surprise medical billing for treatment in the next phase of coronavirus legislation. 

“The insurance companies say they won’t pass on the extra costs, but the hospital might. So if the hospital is billing this and the insurance company is paying that, the patient still may get a bill from the Delta. So I do think we need to take the patient out of the middle,” Cassidy said.

But Fisher believes Congress should also be fighting for price transparency at hospitals. 

“We will know what those prices are. And when we see that that radiologist or that pathologist in that emergency department is going to price-gouge me, do not take me there." she said.

The White House pushed to get price transparency in the last stimulus bill, to no avail. In the meantime, experts say patients have to be their own best advocates. 

“If you get a bill and it doesn't quite seem right, don't just pay it. You can go to your insurance company, you can go to your doctor, and you can also go to your state insurance department. All of them can help you confirm whether you've been billed correctly or not,” suggested Huetteman.