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What’s Behind All the Surprise Medical Bills for COVID-19?

No one likes to be surprised by unexpected bills. Unfortunately, because of the rapidly changing policies relating to medical billing for COVID-19, many people are receiving surprise medical bills—sometimes for thousands of dollars.

Charges for treating the disease can be extremely high because of the extended hospital stays involved, but some people have even received shocking bills for the required testing to determine that they did not have the virus.

Why the Declaration of No Patient Charges for Testing Hasn’t Resolved the Issue

One of the most important aspects of controlling the spread of COVID-19 is testing. When anyone has symptoms that could be caused by the coronavirus, they need to be tested immediately so they can alert anyone they have been in contact with to let them know they have been exposed and could have also become infected.

Without being informed of their status, infected people continue to pass the virus along to numerous others, who in turn can infect many more, leading to an exponential growth in the number of people wo become ill. Testing is the key to controlling the pandemic, but most people are resistant to incurring doctor bills, so making the test free was a vital step to getting anyone who should be tested to go get it done.

Since the test for COVID-19 had to be developed specifically for this virus, it did not previously exist, so wasn’t included in any lists of covered tests. Anyone who has dealt with insurers and government payors will know that they are sticklers for dates and required pre-approvals. Any charges for testing that was done before the regulation was put in place were likely to have been billed to the patient.

Some insurers are correcting the bills so patients do not have to pay, but it has caused a lot of confusion.

Not All Patients Tested Have COVID-19

There are also a lot of people who got tested for the viral infection whose symptoms were caused by a different virus or something else. While the patient may not have been charged for the coronavirus panel, they have been charged for associated tests and procedures.

In many hospitals, COVID-19 testing was conducted in emergency isolation rooms and included chest X-rays, IV drips and multiple swabs. The patient would be relieved to receive the news that they did not have the coronavirus, but later would be quite dismayed when all the bills started piling up because none of these additional charges were covered since they didn’t have the coronavirus after all.

Out of Network Bills Increase Costs to Patients

Hospitals employ physicians and specialists under contracts that may be outside the networks of insurers they participate in. When a patient checks into the hospital that is in-network according to their health insurance coverage, they naturally assume that the staff are included, but it isn’t necessarily so.

Any of the numerous anaesthesiologists, doctors and technicians involved in testing and treating COVID-19 may be out of network and the patient will receive the bill for the increased costs, even though there was no way for them to make that choice or even know about it until they see the charges.

Between government stimulus packages, insurers, hospitals and labs all trying to figure out the best approaches and making new policies and adjusting charges, it will take some time for all of it to get sorted out. In the meantime, medical billing staff have to stay vigilant to keep up with changes and patients will have to follow up with providers and insurers as new agreements are made about charges and responsibility for them.

Medcare MSO provides medical billing and a full suite of medical revenue cycle management (RCM) services. Our clients have been pleasantly surprised to find that not only are they relieved of a huge amount of stress from managing billing and dealing with insurers, but they also make more money. Give us a call at 800-640-6409 to find out how we can help you get the same results.