Archive for April, 2020

CONSUMER BEWARE………..MAKE SURE YOU CHALLENGE YOUR INSURE COMPANY IF YOU  GET A BILL RELATING TO THE CORONAVIRUS!!!!

Even before a novel virus swept around the world, Anna Davis Abel wore a mask to protect herself from getting sick.

The 25-year-old writer lives with lupus, a chronic autoimmune disease that makes her more susceptible to catching a virus or an infection. Davis Abel’s doctor cleared her to travel to a literary conference in San Antonio in early March. Then she developed a sore throat and low-grade fever several days after arriving home in Morgantown, West Virginia.

Consulting a nurse on the phone, Davis Abel was told to manage her symptoms at home. But her symptoms only worsened, so she secured an appointment with her primary care doctor.

“At that point, I was, like, taking shot glasses of Sudafed,” she said.

Given the spread of the coronavirus and a chronic condition that left her vulnerable to a more serious case of COVID-19, she was concerned she’d been infected. To find out, her doctor first ordered tests to evaluate whether Davis Abel’s symptoms were caused by some other respiratory disease. According to the doctor’s notes in her medical record, “we needed to rule out all other viral possibilities before being eligible for the COVID-19 test.”

“Unfortunately at this time, COVID-19 testing is very limited and is not widely available to most patients,” the record noted.

Davis Abel tested positive for influenza Type B.

Then the bill came.

The Patient: Anna Davis Abel is a 25-year-old graduate student studying creative writing at West Virginia University in Morgantown. She is insured through an Aetna plan the university offers.

Total Amount Billed: WVU Medicine charged Davis Abel $2,121 for the visit and testing, according to records. Aetna initially paid $1,584.54 for these services. Abel was responsible for the copay, the remaining amount of her deductible and a coinsurance cost of 20%. In total, she owed $536.46.

The Providers: Davis Abel visited the WVU Healthcare University Town Centre clinic for her primary care appointment. A laboratory within the WVU health system processed her testing for respiratory disease. Both sites were in-network for her plan.

Medical Services: A BioFire Respiratory Panel was used to test a specimen collected from the back of Davis Abel’s nose and throat for more than a dozen respiratory diseases.

What Gives: Congress has taken action to make COVID-19 testing more affordable for consumers with health insurance.

The Families First Coronavirus Response Act requires private insurers to pay for certain services and items related to testing at no cost to the patient. A second piece of legislation, known as the CARES Act, expanded the number of tests and services insurers must cover at no cost. The latter law also requires health plans to reimburse out-of-network providers for their services. However, experts said, there are gaps in these federal protections that may expose patients to unexpected medical bills.

The guidelines state that insurers are required to cover the cost of an appointment without cost sharing only if the doctor orders or administers a COVID-19 test. Even if the patient shows symptoms and receives other care related to the novel virus, without a test the patient may be on the hook for the cost of the visit, said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University.

“They’re getting a battery of other tests,” said Corlette. “But because there’s not enough [COVID-19] tests, they can’t get this protection.”

A national shortage of COVID-19 tests complicates a patient’s ability to qualify for the federal safeguard. Despite efforts by the federal government and the private sector, some resources needed to increase testing remain scarce, said Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists.

This reality means some medical providers, like Davis Abel’s doctor, must rule out other respiratory diseases before ordering a COVID-19 test, leaving some patients with a difficult choice. Do they seek medical attention and risk a high medical bill? Or do they forgo care altogether?

A second hole in these federal protections may leave patients holding the bill for their COVID-19 test, experts said. The law prohibits insurers from charging patients for testing, but it does not block medical providers from doing so. If an insurer does not cover the total amount charged by a provider, the patient may get balance-billed, or slapped with a surprise charge.

Guidance from the federal Department of Health and Human Services says that that should not happen because almost any patient can be considered at risk for COVID-19 right now, but it’s unclear if or how that will be enforced.

If any of you are interested in the whole #COVID19 video @NBCNews used, here you go. I can guess why they edited it 🤪 pic.twitter.com/cawpAMfOkS

— Anna Davis Abel (@AnnaDavisAbel) April 15, 2020

Davis Abel’s appointment was on March 11, making her ineligible for the protections offered by the federal laws. By then, however, Aetna had pledged to cover COVID-19 testing without cost sharing. The hospital system then sent Davis Abel a bill for the remaining amount.

WVU Medicine declined to comment on the case.

It’s unlikely Davis Abel is the only patient getting charged for care, according to Karen Pollitz, a senior fellow at the Kaiser Family Foundation. Pollitz said insured consumers may get dinged with a bill if they get care from an out-of-network provider even though the federal protections also require insurers to cover that cost.

Consumers may find protection from these bills through a requirement attached to federal relief funding for medical providers. Health care facilities that receive any of the $100 billion from the CARES Act Provider Relief Fund are not allowed to balance-bill patients for COVID-19 treatment. (Kaiser Health News is an editorially independent program of the foundation.)

Resolution: Aetna retroactively covered Davis Abel’s bill from the hospital after reporters made inquiries. In a statement, the insurer said it is waiving claims after receiving information from her provider that the services were related to COVID-19 testing.

It also said Davis Abel represents a “unique” case and is not aware of whether other members have submitted claims for services they needed to obtain a COVID-19 test. The insurer said it would waive additional testing related to the novel virus if the provider deemed those services necessary.

Before Aetna took action, two strangers read Davis Abel’s story on Twitter and sent her the full amount for the bill. She used the donations to help pay for a medical bill from a previous procedure.

Nearly 10 days after her appointment, Davis Abel received a drive-thru COVID-19 test offered by the same clinic. Her primary care doctor, who ordered the test, said in an email to Davis Abel that new data suggested patients could fall ill with the coronavirus and the flu at the same time.

Davis Abel’s fever and coughing had not subsided. Eight days after the test, she received her result. Negative for COVID-19. She did not pay for the test.

The Takeaway: Experts recommend that insured patients educate themselves about their health care plan. Seek care at an in-network provider whenever possible. Call the insurer to find out exactly what COVID-19 care it covers. Several insurance companies have pledged to waive cost sharing for treatment.

Uninsured consumers may be able to get a free COVID-19 test several ways, Pollitz said. One way is to visit an outpatient testing area at a facility that received relief funding — the law bars the provider from balance-billing patients for care related to the coronavirus.

Another option is through Medicaid. States may now use the government health insurance program for the poor and disabled to cover the cost of testing uninsured residents who qualify.

A third way consumers could receive a free COVID-19 test is through the National Disaster Medical System. That network of health care providers — generally activated in response to an emergency — treats patients and then charges the federal government for their services, said Pollitz. However, she acknowledged, it may be difficult to find a provider who participates in the program.

“The problem right now is the supply of them,” Sara Collins, vice president for health care coverage and access at the Commonwealth Fund, said about COVID-19 tests. “But once that changes, people need to be confident that they’re not going to be stuck with a big bill.”

Dan Weissmann, host of the podcast “An Arm and a Leg,” reported the audio version of this story. You can hear more about Davis Abel’s story on this week’s episode of the podcast. 

Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

Karen Taylor had been coughing for weeks when she decided to see a doctor in early April. COVID-19 cases had just exceeded 5,000 in Texas, where she lives.

Cigna, her health insurer, said it would waive out-of-pocket costs for “telehealth” patients seeking coronavirus screening through video conferences. So Taylor, a sales manager, talked with her physician on an internet video call.

The doctor’s office charged her $70. She protested. But “they said, ‘No, it goes toward your deductible and you’ve got to pay the whole $70,’” she said.

Policymakers and insurers across the country say they are eliminating copayments, deductibles and other barriers to telemedicine for patients confined at home who need a doctor for any reason.

“We are encouraging people to use telemedicine,” New York Gov. Andrew Cuomo said last month after ordering insurers to eliminate copays, typically collected at the time of a doctor visit, for telehealth visits.

But in a fragmented health system — which encompasses dozens of insurers, 50 state regulators and thousands of independent doctor practices ― the shift to cost-free telemedicine for patients is going far less smoothly than the speeches and press releases suggest. In some cases, doctors are billing for telephone calls that used to be free.

Patients say doctors and insurers are charging them upfront for video appointments and phone calls, not just copays but sometimes the entire cost of the visit, even if it’s covered by insurance.

Despite what politicians have promised, insurers said they were not able to immediately eliminate telehealth copays for millions of members who carry their cards but receive coverage through self-insured employers. Executives at telehealth organizations say insurers have been slow to update their software and policies.

“A lot of the insurers who said that they’re not going to charge copayments for telemedicine ― they haven’t implemented that,” said George Favvas, CEO of Circle Medical, a San Francisco company that delivers family medicine and other primary care via livestream. “That’s starting to hit us right now.”

One problem is that insurers have waived copays and other telehealth cost sharing for in-network doctors only. Another is that Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare and other carriers promoting telehealth have little power to change telemedicine benefits for self-insured employers whose claims they process.

Such plans cover more than 100 million Americans — more than the number of beneficiaries covered by the Medicare program for seniors or by Medicaid for low-income families. All four insurance giants say improved telehealth benefits don’t necessarily apply to such coverage. Nor can governors or state insurance regulators force those plans, which are regulated federally, to upgrade telehealth coverage.

“Many employer plans are eliminating cost sharing” now that federal regulators have eased the rules for certain kinds of plans to improve telehealth benefits, said Brian Marcotte, CEO of the Business Group on Health, a coalition of very large, mostly self-insured employers.

For many doctors, business and billings have plunged because of the coronavirus shutdown. New rules notwithstanding, many practices may be eager to collect telehealth revenue immediately from patients rather than wait for insurance companies to pay, said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University.

“A lot of providers may not have agreements in place with the plans that they work with to deliver services via telemedicine,” she said. “So these providers are protecting themselves upfront by either asking for full payment or by getting the copayment.”

David DeKeyser, a marketing strategist in Brooklyn, New York, sought a physician’s advice via video after coming in contact with someone who attended an event where coronavirus was detected. The office charged the whole visit — $280, not just the copay ― to his debit card without notifying him.

“It happened to be payday for me,” he said. A week earlier and the charge could have caused a bank overdraft, he said. An email exchange got the bill reversed, he said.

With wider acceptance, telehealth calls have suddenly become an important and lucrative potential source of physician revenue. Medicare and some commercial insurers have said they will pay the same rate for video calls as for office visits.

Some doctors are charging for phone calls once considered an incidental and non-billable part of a previous office visit. Blue Cross plans in Massachusetts, Wyoming, Alabama and North Carolina are paying for phoned-in patient visits, according to America’s Health Insurance Plans, a lobbying group.

“A lot of carriers wouldn’t reimburse telephonic encounters” in the past, Corlette said.

Catherine Parisian, a professor in North Carolina, said what seemed like a routine follow-up call with her specialist last month became a telehealth consultation with an $80 copay.

“What would have been treated as a phone call, they now bill as telemedicine,” she said. “The physician would not call me without billing me.” She protested the charge and said she has not been billed yet.

By many accounts, the number of doctor encounters via video has soared since the Department of Health and Human Services said in mid-March that it would take “unprecedented steps to expand Americans’ access to telehealth services.”

Medicare expanded benefits to pay for most telemedicine nationwide instead of just for patients in rural areas and other limited circumstances, HHS said. The program has also temporarily dropped a ban on doctors waiving copays and other patient cost sharing. Such waivers might have been considered violations of federal anti-kickback laws.

At the same time, the CARES Act, passed by Congress last month to address the COVID-19 emergency, allows private, high-deductible health insurance to make an exception for telehealth in patient cost sharing. Such plans can now pay for video doctor visits even if patients haven’t met the deductible.

Dozens of private health insurers listed by AHIP say they have eliminated copays and other cost sharing for telemedicine. Cigna, however, has waived out-of-pocket costs only for telehealth associated with COVID-19 screening. Cigna did not respond to requests for comment.

Teladoc Health, a large, publicly traded telemedicine company, said its volume has doubled to 20,000 medical visits a day since early March. Its stock price has nearly doubled, too, since Jan. 1.

With such a sharp increase, it’s not surprising that insurers and physicians are struggling to keep up, said Circle Medical CEO Favvas.

“It’s going to be an imperfect process for a while,” he said. “It’s understandable given that things are moving so quickly.”

Abbie VanSickle, a California journalist, wanted her baby’s scheduled wellness visit done remotely because she worried about visiting a medical office during a pandemic. Her insurer, UnitedHealthcare, would not pay for it, the pediatrician told her. Mom and baby had to come in.

“It seems like such an unnecessary risk to take,” VanSickle said. “If we can’t do wellness visits, we’re surely not alone.”

A UnitedHealthcare spokesperson said that there was a misunderstanding and that the baby’s remote visit would be covered without a copay.

Jacklyn Grace Lacey, a New York City medical anthropologist, had a similar problem. She had to renew a prescription a few weeks after Cuomo ordered insurers to waive patient cost sharing for telehealth appointments.

The doctor’s office told her she needed to come in for a visit or book a telemedicine appointment. The video visit came with an “administrative fee” of $50 that she would have had to pay upfront, she said — five times what the copay would have been for an in-person session.

“I was not going to go into a doctor’s office and potentially expose people just to get a refill on my monthly medication,” she said.