Federal officials said if hospitals and other providers take emergency funds amid the COVID-19 pandemic, they will be barred from sending balance bills to COVID-19 patients. However, the broad terms HHS uses to describe COVID-19 patients has some analysts interpreting the text as a ban on all surprise billing, according to Kaiser Health News.
HHS Terms and Conditions
In the HHS terms and conditions for eligibility for the emergency relief funds, the agency uses the language: “HHS broadly views every patient as a possible case of COVID-19.” When hospitals received the first wave of funding, they had to sign a form saying that “for all care for a possible or actual case of COVID-19,” the provider wouldn’t charge more out of pocket if the patient’s insurance plan was out of network, a practice known as surprise billing.
As reported in the article, some say that line could ban the practice of balance billing, in which a patient is billed for the difference between what a provider charges and what the insurer pays, a major source of surprise bills ― which can be financially devastating ― for patients. The move caught groups in the surprise billing fight off guard.
“The intent of the terms and conditions was to bar balance billing for actual or presumptive COVID-19,” an HHS spokesperson said in the Kaiser Health news article. “We are clarifying this in the terms and conditions.”
Additionally: “Because the terms and conditions do not appear to be sufficiently clarified, there is a concern that there will be legal challenges around the balance-billing provision,” said Rodney Whitlock, a health policy consultant and former Senate staffer.
Along with HHS, individual states have also taken action to ensure health systems and patients are protected from surprise medical bills during the pandemic. Connecticut adopted a policy to ensure patients are protected from incurring surprise medical bills for treatments provided during the pandemic. Patients who would be out-of-network must be treated as in-network for emergency care provided during the pandemic.