On Friday, March 27, President Trump signed into law the Coronavirus Aid, Relief, and Economic Security Act—otherwise known as CARES. This CARES Act covers the whole $2 trillion megillah stimulus package, but in this health care podcast episode, we’re talking quickly about a provision in that Act.
I speak first with Doug Aldeen, an attorney specializing in helping employers settle hospital bills. Doug works with clients across the country. And then at the end of the episode, you will also hear from Al Lewis, who is a founder over at Quizzify. Al Lewis, as many of you may or may not know—but if you don’t know, you should—created a “surprise billing wallet card” that is actually super relevant to this discussion as you will see. There’s actually going to be a whole surprise billing episode coming up soon where we discuss this wallet card, so you can consider Al’s short commentary today as kind of a coming attraction.
The provision that we’re going to talk about in this episode is the No Cost Sharing for COVID-19 Testing and Vaccines provision. This is where insurers are required to cover testing for COVID-19 without cost sharing to their enrollees, and they must pay for the tests based on contracts or the posted pricing of labs. So, the thing is, hospitals and diagnostic testing companies can essentially basically name their price on COVID-19 tests; and employers and insurers will be required to pay for it. This is in Section 3202, the Price of Diagnostic Testing, in that CARES Act.
The plot thickens this week as health insurers—including Aetna, Cigna, and Humana—are now waiving patient cost sharing on all treatment for coronavirus, not just the testing, including hospitalizations and ambulance transfers. And they’re doing this for their insured members and employer plans at their in-network health systems—emphasis intended on the “in-network” part.
So, you might be thinking, “Great … no costs to anybody!” But I did emphasize that last part for a reason. If you think for a minute about this, just because patients are not paying co-pays for COVID treatments first of all doesn’t mean that while they’re in the hospital that their diabetes won’t flare up … or their MS or their RA. COVID-19 is just one thing, and the US has a patient population that has, let’s just say, no shortage of chronic conditions—otherwise known as underlying conditions, otherwise known as the people most likely to be in the ICU.
My concern is that there’s nothing to say that co-pays and coinsurance for treatment of other things while being treated for COVID are going to suddenly vanish, too, even if it’s an in-network health system. Furthermore, there is that problem of a patient going to a hospital that’s not contracted with the employer plan or the patient’s insurance carrier. At that point, I’m not seeing anything that would suggest that patients with COVID-19 are going to get any different treatment billing-wise than patients with anything else.
We’ve seen COVID-19 bills that are, for uninsured patients, $34,000 and $73,000 in the press. What if the patient doesn’t have out-of-network coverage, for example? What if the patient’s out-of-network deductible is tens of thousands of dollars like some of them are? I don’t see anything in this bill to suggest that those are suddenly going to go away. And, oh, by the way, exactly as the bill pretty much states explicitly, regardless of what the patient pays, the employer’s on the hook to pay for whatever the hospital chooses to charge—at least as far as testing goes.
You can connect with Doug on Twitter at @AldeenDoug and on LinkedIn.
You can learn more at quizzify.com or connect with Al on LinkedIn. You can also connect with Al on Twitter at @quizzify and @whynobodybeliev.
Doug Aldeen is an Austin, Texas–based health care and Employee Retirement Income Security Act (ERISA) attorney who recently served as ERISA counsel on behalf of the Berkeley Research Group in New York City to the $7.7 billion May 2016 acquisition of Multiplan and its medical bill repricing product Data iSight by the private equity firm Hellman and Friedman. Since 1997, he has represented reference base pricing organizations, a bundled payment software platform, PPO networks, medium to small self-funded plans, third-party administrators, and provider-sponsored health maintenance organizations in various capacities, including Herdrich v. Pegram, which was argued before the US Supreme Court in 2001. Moreover, he serves as a resource to national news organizations regarding issues on health care and as a consultant with the Governmental Relations Committee at the Self-Insurance Institute of America in Washington, DC, and as an adviser to RIP Medical Debt, which has abolished over $1.2 billion in medical debt. Doug received his JD from the University of Illinois.
Al Lewis wears multiple hats, both professionally and also to cover his bald spot.
Hat #1: Employee Health Literacy. He is the founder and “quizmeister-in-chief” of Quizzify, whose mission is to help companies teach their employees to utilize healthcare services appropriately, using a format best described as “Jeopardy meets health benefit education meets Comedy Central.” Quizzify is the only vendor authorized to display the Harvard Medical School “Veritas” shield and has received excellent reviews from users.
Quizzify is best known today for its employee coronaquizzes (now exceeding 100,000 plays!) and its surprise billing “Prevent Consent” solution, which was recently featured in the New York Times. It can be taped to an insurance card, used as a stand-alone card, or downloaded into your Apple Wallet.
His quiz-specific background includes authorship of the best-selling Newsweek Presents the Ultimate Trivia Game, which Games magazine lauded as having the best questions of any trivia game; hosting two quiz shows on Boston network affiliates; and appearing on Jeopardy.
Hat #2: Outcomes Measurement. As an author, his critically acclaimed category best-selling book on outcomes measurement, Why Nobody Believes the Numbers, chronicling and exposing the innumeracy of the health management field, was named digital health book of the year in Forbes. Cracking Health Costs, written in conjunction with Walmart alum Tom Emerick, was also a trade best seller. Surviving Workplace Wellness has also received great accolades, and excerpts appeared in Harvard Business Review and elsewhere.
He was the cofounder of the World Health Care Congress’s Validation Institute.
His expertise in outcomes measurement got him named one of the unsung heroes changing health care forever.
He graduated Phi Beta Kappa with honors from Harvard, where he taught economics as well. He also graduated from Harvard Law School, albeit with no honors that time—other than winning their annual trivia contest, of course.
04:12 Hospital billing as it relates to COVID-19.
05:45 Who is “on the hook” for paying these COVID-19 bills.
08:17 “Reasonable payment” in the case of COVID-19.
08:45 Is COVID-19 different than every other billing situation?
10:12 What’s going to come out of the out-of-network COVID-19 costs?
11:29 What employers should be doing right now.
12:50 The takeaway for everyone “bankrolling” COVID-19.
13:26 “This whole thing is tilting towards, ‘Who’s going to pay for all this stuff?’”
13:53 Connecting the dots with COVID-19 billing.
15:25 Using the Quizzify wallet card, and how this can help avoid COVID-19 surprise billing.
16:17 Download the wallet card at quizzify.com.