Kaiser Health News: In Fine Print, HHS Appears To Ban All Surprise Billing During The Pandemic

Apr 17, 2020 | Private Equity

Below are excerpts from Kaiser Health News. Read the full story here.

  • “Federal officials offering emergency funding to hospitals, clinics and doctors’ practices have included this stipulation: They cannot foist surprise medical bills on COVID-19 patients. But buried in the Department of Health and Human Services’ terms and conditions for eligibility is language that could carry much broader implications. It says ‘HHS broadly views every patient as a possible case of COVID-19,’ the guidance states.”
  • “For those immersed in the ongoing fight over surprise medical billing, the possibility that HHS might have done with fine print what Congress and the White House could not do with bipartisan support and ample public outrage caught some off-guard and raised questions about what exactly HHS meant. As the first wave of $30 billion in payouts began to hit bank accounts last week, providers were asked to sign an online form agreeing to the government’s terms. Among those terms is that, “for all care for a possible or actual case of COVID-19,” the provider will not charge patients any more in out-of-pocket costs than they would have if the provider were in-network, or contracted with their insurance company.”
  • “The intent of the terms and conditions was to bar balance billing for actual or presumptive COVID-19,” an HHS spokesperson said late Friday. “We are clarifying this in the terms and conditions.”
  • Lobbyists, advocates and other experts say the ambiguity could be enough to mandate that providers who accept federal funds have agreed not to send surprise medical bills to patients — whether or not they test positive for COVID-19.
  • “If you took the broadest interpretation, any of us could be a potential patient,” said Jack Hoadley, a professor emeritus of health policy at Georgetown University and former commissioner of the Medicare Payment Advisory Commission.
  • “Frederick Isasi, executive director of Families USA, a nonprofit that advocates for health care consumers, said the group supports the administration’s guidance ‘wholeheartedly’ but urged lawmakers to enshrine broad protections against surprise billing into law. ‘It’s time to just ban them permanently, not just related to COVID,’ Isasi said, adding: ‘Families should avail themselves of this as broadly as possible.'”