According to a recent study by the Peterson-KFF Health System Tracker, a patient could incur more than $20,000 of medical bills for complications related to COVID-19 with an even steeper cost when ventilator support is required. This means potentially high cost sharing can be expected in terms of deductibles and out of network balances.
The majority of insurance companies are waiving cost sharing for COVID-19 testing and some are also covering treatment with out of network charges not being balance billed to the patient. It is critical you understand your coverage benefits, ask questions, and monitor payment coverage updates as they become available. Below are additional steps to take.
What Coverage Terms Does Your Insurance Plan Provide?
Federal laws now mandate insurance providers to cover the entire cost of COVID-19 testing and screening. With this new law, you will not be responsible for deductibles or co-payment of any doctor’s screening that results in a COVID-19 test. However, your healthcare provider may still bill you. If you elect to pay, obtain an itemized receipt and submit to your insurance plan for reimbursement.
What Additional Out of Pocket Costs Will I Incur?
As mentioned above, some insurers are also waiving treatment costs associated with COVID-19, limited to a specific time frame. Check with your insurance carrier what services and procedures are waived and the criteria that must be met for such charges to result in no patient cost sharing.
What if I have Services Provided Via Telehealth?
Telehealth services are becoming more mainstream and acceptable treatment options that may be covered by your insurance plan. Federal plans have expanded coverage and are waiving some mandatory requirements for payment approval to enable patients to receive care without leaving their home.
What Do I Do When I Receive an Unexpected Medical Bill?
When you receive a bill with a remaining balance and you believe it is an error, always double check with your insurance plan. Several states have adopted no balance bill laws in certain situations (i.e. emergency room treatment). And, to add confusion, the medical provider may not have a contract with your specific insurance plan, which means they can bill for the remaining balance; however, your Explanation of Benefits (EOB) may state patient responsibility is $0.00. Remember, when you do not agree with the claim decision, you have the right to appeal. You must follow your plan’s instruction and submit the appeal within their time frame for consideration. The appeal information can be located on your EOB.
Will My Doctor Discount or Negotiate My Balance?
You won’t know unless you ask. Do your homework first though. Research the “blue book” cost of your procedure or test using one of the reputable online sites like Fair Health Consumer. Once you have a baseline cost also contact your insurance plan to determine how much they will or will not cover. Request to receive any estimates in writing. (Know that your procedure may have had unexpected specialized services or complications that would not be included in an estimate or baseline cost analysis.)
Many providers will work with you and your situation – you must ask. Some may have discounts for uninsured patients, those who agree to pay in cash or other financial incentives regardless of a patient’s income level.
Finally, it is important to be your own advocate by educating yourself on your insurance plan coverage, question anything you do not understand, and initiate the financial discussion. You may have to complete multiple follow up contacts to receive resolution so maintain a detailed communication log.