12/3/2020 by Share Your Story

The Uninsured: Who Pays the Covid Bills?

While the CARES Act exists in part to help cover Covid testing for the uninsured, there are roll out issues and some loopholes.


Covid testing for the uninsured

The Coronavirus Aid, Relief, and Economic Security (CARES) Act was released in response to the COVID-19 pandemic to protect people. Provisions within the Act included coverage for uninsured individuals seeking diagnosis and care for COVID-19–related conditions, so that hospitals and clinics providing care to these patients are reimbursed, often at Medicare rates. Covid testing for the uninsured can present a significant cost. Once a vaccine against the SARS-CoV-2 virus is approved, that too would be covered for the uninsured under the CARES Act. Another potential cost.

However, it turns out, the message may not be reaching the uninsured population. This is important in the context of the huge number of job losses and other economic hardships that the population is facing during the current crisis.

Limitations of the Program

A recent report from KFF shows that HHS has only made limited payments on Covid testing for the uninsured patients seeking care. Additionally, patients may not have comprehensive access to care. Turns out there is a technicality that only those uninsured patients who have a primary diagnosis of COVID-19 will be reimbursed by HHS. The American Medical Association has pointed out that sometimes patients may be given a different primary diagnosis (such as sepsis), and even if those symptoms are related to COVID-19, the care provider may not get reimbursed.

Turns out there is a technicality that only those uninsured patients who have a primary diagnosis of COVID-19 will be reimbursed by HHS. #uninsured Click To Tweet

Providers have to “opt-in” or choose to participate in this program to be eligible. The patient may be directly billed by the clinic or hospital if the provider isn’t the CARES Act program. Patients would also be charged a higher list price, not the lower Medicare price that CMS negotiates with providers. Finally, reimbursement for participating providers is contingent on the availability of funds with HHS.

Providers have to “opt-in” or choose to participate in this program to be eligible. If a provider is not a participant in this program offered under the #CARESAct, the patient may be directly billed by the clinic or hospital.… Click To Tweet

The program covers outpatient visits, ambulance rides, medical equipment, and care in a skilled nursing facility. However, prescriptions to be taken at home post release from a hospital, or any other treatment that the individual may need for their chronic condition are not covered.

Lack of Messaging

Reports from Kaiser Health News (KHN) and The New York Times (NYT) identify serious shortfalls within the program. Hospitals in the program are not required to inform the individuals or patients that the federal government is covering the cost of their COVID-19 testing and follow-up care. Case studies in the reports from KHN and NYT show revealed more. Uninsured patients who tested positive skipped follow-up care out of fear of the financial burden associated with care. Hospitals have billed patients thousands of dollars for treatment and hospitalization costs. Meanwhile the reimbursement claims need to be made with the federal government. Since patients are not aware of the provisions of the CARES Act, they do not dispute the bills.

This has amounted to a lot of confusion among both patients and care providers. It could have a significant bearing on patient health. Patients may defer seeking care for any subsequent COVID-related complications out of fear of being unable to afford the cost of Covid testing for the uninsured.


Additional Resources

  1. CARES Act, what is covered for the uninsured and those who are insured: https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-patients/index.html.
  2. What will patients pay for COVID-19 testing? https://patientsrising.org/pay-for-covid-19-testing/.
  3. 3. Support funds for COVID-19 treatment: https://www.panfoundation.org/covid-19-financial-support-fund/resources/.

Additional Reading from Patients Rising:

What Will Patients Pay for Covid-19 Testing?

The Covid-19 Treatments in Development

 


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