If the stress and anxiety associated with the Coronavirus/Covid-19 pandemic were not enough, people who must go to doctors, clinics or hospitals, because of the virus or anything else, may also be more likely to receive a nasty surprise in the form of a much higher than expected bill. This bombshell applies even to those who have insurance and follow all the rules dictated by their healthcare insurance provider. Houston based neurologist Dr. Steven Goldstein explained how a bad situation is now much worse on his podcast. But he also discovered a reason for some optimism as the beginning of the end of surprise bills is here. The Houston Healthcare Initiative podcast can be heard on the following locations: Soundcloud, iHeartRadio, Spotify, and iTunes.
How We Get Surprise Medical Bills
Surprise billing occurs when the patient is billed for the difference between what a provider charges and what the insurer pays. Physicians who are not part of the patients’ insurance network will bill at a much higher rate, one that the patient must pay. The hospital is not required to inform the patient about this. Such charges are a major source of surprise bills and can be financially devastating for patients. This practice is banned in several states, though not federally. “It’s terribly unfair because even when someone follows all the rules and goes to a clinic, hospital or emergency room that is covered in their insurance network, they may still get zapped with really high charges they did not expect,” Dr. Goldstein told his audience. “The added attention to the surprise bill phenomena informed many patients to require only in-network medical staff attend them. But the current medical situation makes that less likely or even possible.”
How This Problem Is Worse During The Pandemic
The Coronavirus/Covid-19 outbreak makes greater demands on the medical community to treat existing patients and those who have or believe they have the virus. Surprise medical billing occurs when a patient receives treatment from an out-of-network physician at an in-network facility. Even for those who are not experiencing Coronavirus/Covid-19 symptoms, the added demand and stress the virus brings leads to staffing shortages. “Triage protocols make it more likely that patients, regardless of their condition, will be sent to out-of-network facilities and be seen by out-of-network providers,” Dr. Goldstein said. “All during a time when patients cannot check providers’ network status or even know what to ask.” More demand means added pressure to augment staff to hospitals and other medical facilities during the pandemic. “This means that some of these recently recruited professionals when added to clinic payrolls, are not part of that institutions’ insurance network, never mind the patients,” Dr. Goldstein said.
Possible Remedy?
The U.S. Department of Health and Human Services (HHS) is responsible for distributing billions of newly approved financial aid to the healthcare industry. Those federal officials included a stipulation in the regulations stating that those who accept the aid cannot impose ‘surprise’ medical bills on COVID-19 patients. Further, HHS considers every patient as a possible case of COVID-19.
The intent of the terms and conditions for treating Covid-19 and accepting federal money was to bar surprise billing for actual or presumptive COVID-19 patients. “That ‘everyone’ is considered a Covid-19 victim now is really broad and was not passed as part of any legislation,” Dr. Goldstein said. “So, let’s not get too excited about this just yet.”
According to Dr. Goldstein, the healthcare industry will ask lots of questions about this requirement for accepting that money while they are at the same time, accepting the Coronavirus/Covid-19 aid money. Lobbyists, lawyers and other experts say the uncertainty of this broad requirement could be enough to prevent the ban on the surprise bills all but moot.
Every Patient Is A Covid-19 Patient
The other side is that providers who accept federal funds have agreed not to send surprise medical bills to patients — whether or not they test positive for COVID-19 or not. “The blanket assertion by HHS officials that “every patient” is considered a COVID-19 patient, offered without further clarification, seems to go beyond the administration’s announcement and likely opens the door to lawsuits over whether HHS intended to ban balanced or surprise billing entirely,” Dr. Goldstein said. “With not just these newly minted federal funds at stake but the future of a really big source of revenue for the healthcare industry on the table, there will be a lot of time in court and with lobbyists over this.”
The End of Surprise Medical Bills
While he concedes there is still much wrangling to come, Dr. Goldstein believes that the end has come for surprise medical bills. The federal government using its power to compel healthcare facilities and professionals to end surprise bills or risk not getting billions in federal funding is the biggest. But there are other reasons. Half the states have also taken action to ensure health systems and patients are protected from surprise medical bills during the pandemic. Patients who would be out-of-network must be treated as in-network for emergency care provided during the pandemic. Not to be forgotten is the American voting public who views surprise medical bills as one of its top healthcare issues; and there is an election in November. Fifty-six percent of Americans said legislators should address surprise medical bills, according to a 2019 Kaiser Family Foundation Tracking Poll. “So yes, while the healthcare industry will not go quietly this is probably the end of surprise bills” Dr. Goldstein said. “But remember, I said probably.”
About Houston Healthcare Initiative And Dr. Steven Goldstein
Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.
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