States Can Prevent Surprise Bills for Patients Seeking Coronavirus Care

The ongoing COVID-19 pandemic raises the stakes in the debate over surprise medical bills. Consumers’ fear of incurring medical bills could lead some to avoid testing or treatment. While new federal laws require insurers to waive cost-sharing for COVID-19 testing and the associated medical visit, that protection does not extend to treatment. Nor does it prevent balance billing if a patient is treated by an out-of-network provider or facility. Protection, however, may come with the CARES Act Provider Relief Fund. Providers accepting these funds must agree not to send balance bills to any patient for COVID-related treatment. The effectiveness of this protection will depend on its implementation.

Many states already have stepped up to help protect consumers, such as by creating a special enrollment period for state-based marketplace plans, requiring insurers to eliminate cost-sharing for coronavirus testing, and allowing early prescription refills. Several states have even eliminated cost-sharing and deductibles for treatment services.

In their latest post, Jack Hoadley, Maanasa Kona, and Kevin Lucia explore the ways in which states have taken action in 2020 to enact balance billing protections more broadly as well as the ways in which some states have used their emergency powers to expand or create balance billing protections specifically with respect to COVID-19 services.

This blog was originally posted from the Georgetown Center on Health Insurance Reforms.