Some Texas insurers waive fees, not virus treatment costs
Several insurers are waiving the testing costs for Texans who think they might be infected with the new coronavirus. But that doesn’t guarantee that the tests, or treatment for the virus, will be affordable.
The commitment last week from private health plans covers the test itself, not other costs that might be attached, such as facility and physician fees, according to the Texas Department of Insurance. Those additional costs are normally included in emergency room visits and may or may not be covered by a person’s insurance.
The agreement also only includes state-regulated plans, leaving uncertainty for those who have federally regulated plans, self-funded plans through their employers, or no insurance at all.
“This is a very dynamic situation,” a spokeswoman for the insurance department said in an email. “We’re closely monitoring the situation, and we’ll adjust our guidance as needed.”
Officials are urging people to contact their insurer if they have any questions about what is covered. Those without insurance should call 211 for help finding a low- or no-cost provider.
The confusion comes as the state scrambles to increase testing capacity, hoping to be able to process thousands of new tests by the end of the week.
Baylor, Scott and White now runs mobile testing clinics in Central Texas, and is offering free pre-test screenings for people who have symptoms of the virus. The hospital said it is billing insurance companies for the tests, but expects out-of-pocket expenses for patients to be waived by the plans.
“No patient deemed appropriate for a COVID-19 test by a Baylor Scott & White provider will be denied the test regardless of their ability to pay,” a spokeswoman said in an email.
A patient’s experience
Eva Rovin, who was tested at one of the mobile clinics in Austin over the weekend after she experienced chills, chest pains and a cough, said she was not charged at the clinic, and was not asked to sign any paperwork about billing at the time.
“No one mentioned it, and I didn’t have to sign anything — there was no contact other than the test itself,” she said in a message. Rovin, who is 42 and uninsured, said her test came back negative.
Last week, the insurance department and Gov. Greg Abbott asked state-regulated plans to waive costs associated with the virus, including copayments and deductibles, medical equipment and penalties for out-of-network care. Nearly all of them agreed to waive fees for the tests.
The American Health Insurance Plans, a lobbying group for the industry, has said major insurers will waive copays for testing across the country. Doctor visits for people who need referrals for testing will be covered based on a person’s insurance, according to the outlet Axios. The protections do not include treatment.
Stacey Pogue, with Center for Public Policy Priorities, a leftleaning think tank, said the state should make sure insurance covers both diagnosis and treatment of the virus, and that there are protections in place for the uninsured. Texas has the highest rate of uninsured people in the country; the number of uninsured grew in 2018 to 5 million, according to the U.S. Census Bureau.
“The clearer we can make it as a state for how much people are going to pay, the better we can meet our public health goals,” Pogue said.
Law on no surprise billing
The pandemic will be a test for the state’s new law against surprise medical billing, which Pogue lobbied for and which went into place this year. It prohibits surprise bills for patients that go to in-network hospitals but are seen or receive services by out-of-network providers.
Pogue is confident that the new protections will be effective for those with state-regulated insurance. If someone gets tested at a hospital that’s in-network, for instance, and an out-of-network lab analyzes the test, the law protects them from getting a surprise bill. But the same protections aren’t in place yet for self-insured plans, which make up 61 percent of workers with employer-provided health benefits, according to the Kaiser Family Foundation.
Federal lawmakers are still at an impasse over legislation on surprise medical billing, and are hoping to reach an agreement on national protections in May.
People have state-regulated insurance if their insurance cards have the symbols “TDI” or “DOI” printed on them.
Meanwhile, major health plans are not waiving costs for treatment of the virus, which can be expensive, especially for older patients and those with chronic illnesses. The Texas Association of Health Plans said Tuesday that treatment will be covered like other illnesses.
“Just like the flu and other infectious diseases, members may be responsible for co-pays or other types of cost-sharing related to their treatment,” CEO Jamie Dudensing said in a statement.
In a brief on the virus last week by the Peterson Center on Healthcare and the Kaiser Family Foundation, analysts said the average cost in 2018 of treating pneumonia, a comparable illness, ranged from about $10,000 to $24,000, depending on severity and where the person was treated.
Out-of-pocket expenses were on average about $1,400.