Hospitals around the country are afraid to send out hundreds of thousands of bills related to COVID-19 testing. That’s because Congress mandated there would be no copays and no out-of-pocket costs
for patients. But many employers with self-funded health plans seem to believe they’re exempt from the rules.
“As many as half of those patients potentially have some out-of-pocket [cost], either for the tests or for companion services with the test,” VUMC Chief Financial Officer Cecelia Moore said. So BlueCross BlueShield of Tennessee may be on an employee’s insurance card, but the insurer is just managing the payments. The employer’s money pays the claims; these plans are often called self-funded or self-insured, and it may not be clear to employees that they are in such a plan.
The National Alliance represents employers with self-funded health plans. He said some are not waiving copays and other bills. Most are, he said, though sometimes only bills for the COVID-19 test itself and not for the doctor’s visit or the test to rule out the flu. Duke Health in North Carolina confirms it’s not billing claims related to COVID testing or treatment, citing a lack of clarity in what the patient is responsible for paying. In California, UCSF Medical Center is also holding off on billing, and UCLA Medical Center is pressing health plans to pay their part.
The issue extends beyond academic medical centers. Envision Health, a Nashville-based firm that staffs and operates hundreds of emergency rooms around the country, is holding back 200,000 bills related to COVID-19 testing because of confusion about coverage of cost sharing.
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