What COVID-19 Means for Surprise Billing

March 23, 2020

The last thing anyone impacted by COVID-19 needs is an unexpected medical bill. Yet health insurance industry experts say that likely will happen to some patients. 

Surprise medical billing occurs when patients unknowingly receive care from a health care provider or hospital outside their insurer’s network. The patient is then directly charged for the uncovered treatments, which can be expensive.

It is an all-too-common occurrence. One out of six emergency room visits in 2017 generated out-of-network charges, according to the Kaiser Family Foundation.  And the problem is growing. The percentage of out-of-network bills linked with emergency room visits by commercially insured patients grew from 32.3% in 2010 to 42.8% in 2016. 

The average potential cost of those bills during that same time period skyrocketed, almost tripling from $220 to $628. For inpatient admissions, the average cost of surprise billing grew to more than $2,000.

COVID-19 may heighten the damage done by out-of-network charges. Many people could receive surprise bills just after they have lost their jobs or seen their savings decimated by the slumping economy. Fear of hefty medical bills could deter sick people from getting tested and treated, increasing the risk to public health. But heightened public attention on COVID-19 could also have a positive effect – spurring policymakers to finally address the issue of surprise billing.

Surprise billing has been on lawmakers’ radar for some time, but they have yet to approve legislation addressing it. Even though bipartisan agreement exists on bills in both the U.S. House and Senate, disagreements between insurers, employers, health care providers, and hospitals about the best way to resolve the issue have stymied passage. With the coronavirus dominating policymakers’ attention, a standalone fix for out-of-network billing could well be delayed until the end of 2020.

But it is also possible that emergency legislation to address COVID-19 could include provisions to end surprise billing.  Lawmakers from both parties are proposing protections against out-of-network charges as part of their $1 trillion plan to respond to the health care and economic challenges of the virus.

A number of Americans could be headed to hospital emergency rooms in the coming weeks. If legislators want to make sure these patients don’t have surprise bills adding financial misery to their physical ailments, now is the time for policy solutions.

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