PPE is hard to come by and medical costs for care are on the rise with Covid-19. Even before a patient sees a doctor, many are left to wonder if they are covered. Every aspect of this viral disease is a costly endeavor for the provider as it infects their offices, requires expensive tests, procedures and experimental drugs. The billing codes are just being released as providers scramble to pay for care and deal with governments telling them to share equipment.
Medical providers are often independent businesses that are not state-run in the USA. They rely on state monies and support through medicare, medicaid, and family health plus programs that are funded by federal and state budgets; made available to providers through patient insurance usage. Medical providers have their own boards, business loans, corporate structures and standards. National standards are forever improving coverage and care but the rapid need that this virus presents, results in a wide variety of approaches. This includes the approach used to pay for service.
First, we all know that staying home, social distancing and handwashing are some of the best ways to minimize the risk of exposure as the virus passes from water droplets that have disturbingly long active virus shelf lives on surfaces.
Second, we know that medical providers must care for you if you need help. Each office has a standard protocol and ask that you call before you go. There are drive-thru testing centers that you make an appointment to visit. It can be best to report signs of the illness early to be able to claim specific medical coverage and for loss of wages.
Third, if someone has to be admitted to the hospital they cannot have visitors during their stay. If someone transports someone for testing it is asked that all parties quarantine themselves for at least 14 days or longer. Agencies may call someone to make sure that they are doing well.
Fourth, having to care for the bodies that result from this illness has put a strain on some areas. This is where medical facilities may have suggestions for you on how to properly care for loved ones.
All of these services have costs and as your advocate, we ask what happens to the bill? Who is covered and for what and for how long?
The CARES Act has created funding for providers directly who are covering Covid-19 care and funding for insurance providers. This has led to providers covering the cost of care for those who are uninsured and are diagnosed or are presumed to be infected with Covid-19 and for insurance companies to cover the cost for their members.
Cost-sharing for Medicare Advantage, Medicaid, Individual and Group Market health plan members during this emergency period has been waived for Covid-19 related testing and treatment for fully-insured health plan members until May 31, 2020. As this problem persists many ask what will happen after this deadline.
Insurance companies are also covering the costs of tests and treatment as stated on their company sites. If someone has an insurance policy it is recommended that they seek the advice of their insurance provider to ensure that they still seek care within their coverage network to make billing easier for all parties.
One of the caveats to care coverage is actually being diagnosed and treated for Covid-19. This can be problematic when a patient is not tested before passing or if they get a false negative result, as imported tests have been shown to fail in the thousands. If you believe that you had Covid-19, had to be treated and have received a bill, please connect with a Medical Insurance Advocate who can help fight your case for coverage.
Medicare and Medicaid Coverage and Payment
The CARES Act suspends Medicare “sequestration”—the current across-the-board annual 2 percent reduction in Medicare payments—from May 1, 2020, to December 31, 2020.
Direct Medicare payments for Medicare beneficiaries hospitalized with COVID-19 during the emergency are being increased by 20 percent. The act significantly expands the eligibility for, and the benefits of, accelerated and advance Medicare payments, particularly for those hospitals experiencing significant cash flow challenges, and relaxes various rules related to such accelerated payments.
The Centers for Medicare & Medicaid Services announced immediate implementation of coverage for available vaccines if and when developed by the Medicare program without any Medicare beneficiary cost share and before application of the Part B deductible. Medicaid will cover diagnostic products for COVID-19 even if not approved by the Food and Drug Administration (“FDA”).
The CARES Act also delays the $4 billion Medicaid disproportionate share payment reduction for hospitals until November 30, 2020. Pushing back the reductions in each succeeding year through 2025.
States are granted the option to expand Medicaid coverage of COVID-19 diagnostic tests and related services to uninsured individuals who would not otherwise qualify for Medicaid. However, the CARES Act does not expand health coverage to include COVID-19 treatment more generally to uninsured individuals.
Providers should apply for aid from the CARES act directly and they will get a stimulant payment automatically if they already accept medicare and medicaid payments. Access to the provider relief fund is available here: https://covid19.linkhealth.com/#/step/1