Q. People are worried about receiving surprise medical bills after having been treated for COVID-19. To what extent will the person be responsible for all the treatment received during their stay in the hospital?
A. There is a federal law in place that covers the cost of COVID-19 testing, but there is no federal legislation regarding costs of the treatment of the virus, such as hospitalizations or extended care. Treatment costs depend on the type of health coverage the patient has.
According to the Kaiser Family Foundation, a nonprofit, nonpartisan organization that covers health policy and health issues, people with large employer-sponsored insurance face lower COVID-related costs than those with coverage through small businesses and the individual market, since the latter two forms of health coverage generally have higher deductibles.
Some states have required all state-regulated insurers to waive cost-sharing for COVID-19 treatment, but Connecticut is not one of them. Some insurers have voluntarily waived some or all treatment costs, according to KFF, while for self-funded plans, employers decide whether treatment costs will be covered or not. America’s Health Insurance Plans (AHIP), the national association whose members provide health care coverage, has a detailed list of COVID-19 coverage by provider here. And, according to KFF, providers who receive grants through the federal CARES Act can’t “balance bill” patients – for costs beyond what the insurer is willing to pay — for care provided to patients with presumptive or confirmed cases of COVID-19.
Ted Doolittle, the state’s Healthcare Advocate, urged consumers to question any surprise bills they receive for COVID-19 treatment. His office provides information on healthcare insurance enrollment, coverage or billing questions; claim denials or pre-authorization issues; explanations regarding a healthcare benefit, program or coverage; an assessment of the healthcare plans offered in Connecticut; consumers’ rights and responsibilities as a healthcare plan member; referral and pre-authorization procedures required by a healthcare plan; and help with healthcare plans’ internal and external appeals processes.
Those with Medicare are covered for COVID-related inpatient hospital and skilled nursing facility stays, some home health visits, and hospice care under Part A. Under Part B, outpatient services, including physician visits, emergency ambulance transportation and emergency room visits are covered.
Those covered by Medicaid have little to no cost-sharing. The Families First Coronavirus Response Act requires states to cover COVID-19 treatment for those with Medicaid without cost-sharing as one of the conditions to access an increase in the federal match rate for Medicaid.
Those with no health insurance may be able to access free services. The government has set aside a portion of the funding for hospitals and other providers included in the CARES Act to help pay for treatment for those with no insurance. Providers can apply to this fund to be reimbursed for treating an uninsured patient. Providers can also decide on a case-by-case basis whether to bill an uninsured patient or apply for reimbursement.