Episode Details

On Friday, March 27, President Trump signed into law the Coronavirus Aid, Relief, and Economic Security Act—otherwise known as CARES. This CARES Act covers the whole $2 trillion megillah stimulus package, but in this health care podcast episode, we're talking quickly about a provision in that Act.

I speak first with Doug Aldeen, an attorney specializing in helping employers settle hospital bills. Doug works with clients across the country. And then at the end of the episode, you will also hear from Al Lewis, who is a founder over at Quizzify. Al Lewis, as many of you may or may not know—but if you don't know, you should—created a "surprise billing wallet card" that is actually super relevant to this discussion as you will see. There's actually going to be a whole surprise billing episode coming up soon where we discuss this wallet card, so you can consider Al's short commentary today as kind of a coming attraction.

The provision that we're going to talk about in this episode is the No Cost Sharing for COVID-19 Testing and Vaccines provision. This is where insurers are required to cover testing for COVID-19 without cost sharing to their enrollees, and they must pay for the tests based on contracts or the posted pricing of labs. So, the thing is, hospitals and diagnostic testing companies can essentially basically name their price on COVID-19 tests; and employers and insurers will be required to pay for it. This is in Section 3202, the Price of Diagnostic Testing, in that CARES Act.

The plot thickens this week as health insurers—including Aetna, Cigna, and Humana—are now waiving patient cost sharing on all treatment for coronavirus, not just the testing, including hospitalizations and ambulance transfers. And they're doing this for their insured members and employer plans at their in-network health systems—emphasis intended on the "in-network" part.

So, you might be thinking, "Great … no costs to anybody!" But I did emphasize that last part for a reason. If you think for a minute about this, just because patients are not paying co-pays for COVID treatments first of all doesn't mean that while they're in the hospital that their diabetes won't flare up … or their MS or their RA. COVID-19 is just one thing, and the US has a patient population that has, let's just say, no shortage of chronic conditions—otherwise known as underlying conditions, otherwise known as the people most likely to be in the ICU.

My concern is that there's nothing to say that co-pays and coinsurance for treatment of other things while being treated for COVID are going to suddenly vanish, too, even if it's an in-network health system. Furthermore, there is that problem of a patient going to a hospital that's not contracted with the employer plan or the patient's insurance carrier. At that point, I'm not seeing anything that would suggest that patients with COVID-19 are going to get any different treatment billing-wise than patients with anything else.

We've seen COVID-19 bills that are, for uninsured patients, $34,000 and $73,000 in the press. What if the patient doesn't have out-of-network coverage, for example? What if the patient's out-of-network deductible is tens of thousands of dollars like some of them are? I don't see anything in this bill to suggest that those are suddenly going to go away. And, oh, by the way, exactly as the bill pretty much states explicitly, regardless of what the patient pays, the employer's on the hook to pay for whatever the hospital chooses to charge—at least as far as testing goes.

You can connect with Doug on Twitter at @AldeenDoug and on LinkedIn. You can learn more at quizzify.com