With hundreds of COVID patients at their doors, physicians all around America were not sure how to reimburse their services. It was due to the Congress announced a no copayment and no out-of-pocket cost for COVID patients. The uncertainty was quite obvious across many healthcare organizations and medical billing services.
Amidst this uncertainty, Vanderbilt University Medical Center in Nashville, Tennessee worked with full efficiency and single-handedly carried out testing in much of the state. There was no other facility that competed with the clinical abilities of this lab.
The COVID-19 Testing Laws
In March, Congress passed two laws as the Families First Coronavirus Response Act and the CARES Act. These acts state that COVID testing has to be covered by insurance plans, and patients wouldn’t have to pay a cent for any of the COVID-19 testing services. But the ground reality states otherwise.
It is observed that many patients have to pay out of their pockets, which may be for the COVID-19 test or for other services that accompany these tests. Holding back the out-of-pocket cost from patients is not appropriate, as it will result in surprise bills, which is already a thriving problem in our healthcare industry.
Where do we go from here?
The interpretation and implementation of the legislation are very important to depict where we will go from here.
The business organizations having hundreds of employees buy healthcare plans for their employees and pay claims on their behalf. The majority of Americans has this service and pays their dues in emergencies via funded insurance plans.
However, no matter what the healthcare plan is, often, insurance companies manage payments, and employers make the payment.
The irony is many companies despite knowing the new legislation operate in a way that new rules don’t apply to them. These self-funded plans are not waiving off copayments. They sometimes do pay for the COVID-19 test but not for the doctor’s visit for flu or any other related symptom. This system of payment is very confusing for patients.
What do healthcare experts think?
Healthcare specialists and leaders think that either patient has a self-funded healthcare plan or a fully insured plan by his company, even if the plan is bought from the market, all these private insurance should be able to cover the expense for the coronavirus testing. However, the employers are arguing that it shouldn’t be the case, and it is happening in many states of America.
Many healthcare organizations are saying that they are not billing for COVID -19 testes or treatment, which sometimes creates ambiguity in the patient’s financial obligations.
Many medical practices, on the other hand, are connecting with the medical billing companies and insurance companies to recompile claims as par the CARES Act guidelines.
There are examples of healthcare facilities as NYU Langone Health and Cleveland Clinic, which is willing to offer free COVID-19 services, even if it means bearing loss for their revenue.
Having said that, the new act possesses much confusion among healthcare stakeholders, and therefore, many facilities are also holding back coronavirus related claims that whether they’ll be paid for it nor not. The financial loss is getting higher and higher due to the economic situation going on in America. Either government bears the whole expense for COVID-19 tests or the patients will have to be ready for surprise medical bills. To be honest, the financial dent will have a prolonged impact on the healthcare industry. Many people have lost their jobs, and if the insurance companies pass them along with deductible or copayment, they might not pay for the treatment, and hospitals and clinics can’t bear this much revenue loss for a long time.