Long before the arrival of novel coronavirus, surprise medical billing was a fatal flaw in the U.S. health care system, putting countless Americans at risk for serious financial damage.
Now, the spreading virus and the disruption of the health care system has intensified that risk, leaving families across the nation exposed to exorbitant medical bills for seeking treatment for COVID-19. Congress needs to take action now to protect American families and ensure that everyone who needs treatment can get it without fear of receiving unexpected medical bills.
#1 As hospitals reach capacity, people needing care may be forced to seek treatment from out-of-network providers through no fault of their own.
Surprise medical billing occurs when families receive expensive and unexpected bills from providers outside their insurers’ networks. While insurers may cover part of the bill, patients are on the hook for the remaining balance. As a growing number of people become infected with the coronavirus and seek care — further straining and disrupting the health care system — people may have no other choice but to get care from out-of-network providers.
#2 Surprise medical bills are often rendered by providers for services in which patients typically have little to no choice of their provider. That’s troubling for COVID-19 patients.
Before the pandemic, patients were most likely to get surprise medical bills during a visit to an emergency room or treatment from an anesthesiologist, pathologist, radiologist, and assistant surgeon — as well as labs. These are many of the same services and providers that are expected to treat COVID-19 patients, who likely will not have a choice of whether their provider is in-network. On average, out-of-network emergency physicians and anesthesiologists charge 800 percent of what Medicare would pay for the same service, leaving patients potentially exposed to very high out-of-network bills.
#3 The federal emergency funding legislation covered coronavirus testing but does not do enough to address the very high costs many privately insured individuals could face.
While Congress waived cost-sharing for patients with private insurance for the coronavirus test and other related services, it failed to protect COVID-19 patients from surprise medical bills for treatment. As the economy enters a recession and more people need health care, there are no federal protections prohibiting providers from sending surprise medical bills to patients. While there are several state laws in place to protect against surprise billing, those often only apply to those enrolled in state-regulated insurance plans. Federal action is needed to protect the remainder of people with employer-sponsored insurance who account for the majority of workers with insurance. A federal law is also needed to protect those who live in states with no protections at all.
#4 Those on the front lines of the epidemic face a high risk of infection and financial hardship.
Almost half of Americans with private insurance have a high-deductible health insurance plan — and that includes the first responders who are on the front lines of the epidemic who face some of the greatest risks of becoming infected with novel coronavirus. Nearly 40 percent of Americans are unable to afford a $400 bill. By some estimates, COVID-19 treatment could cost up to $74,310 for out-of-network care.
Those on the front lines and vulnerable to catching coronavirus — such as personal care aides, paramedics, nursing assistants and grocery store workers — often earn low wages and face huge risks for getting hit with surprise medical bills for expensive treatment, such as ICU stays and ventilator use.
#5 There was broad bipartisan support for surprise billing reform before COVID-19. The pandemic has created new urgency to fix this fatal flaw in the U.S. health care system.
Americans have long wanted a fix for surprise billing. A poll by Arnold Ventures last year showed nearly all (94 percent) of U.S. voters think that Congress should take action to protect patients from those bills. In response, lawmakers from across the political spectrum had been actively debating different approaches and reached a bipartisan, bicameral agreement on a solution.
During the negotiations on the stimulus packages, a ban on surprise billing was considered but ultimately left out of the final package, reportedly amid heavy lobbying by special interest groups, such as private equity-backed providers that use surprise billing as a business model.
Congress is now eyeing a fourth relief package — surprise billing protections should be included to ensure that families can get the care they need without facing financial disaster.
Update: The Trump Administration recently announced that hospitals accepting money from the $100 billion bailout for health providers must agree not to send surprise medical bills. This is a reasonable expectation for hospitals receiving federal bailout money, but there are many potential holes in this policy that could leave Americans still at risk for surprise medical bills.