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COVID-19 and Copays: What Responsibility Do Patients Have

fhlf covid and patient responsibility for copaysBy: Dean Viskovich

COVID-19 has affected all aspects of everyday life and healthcare rules and regulations are no exception.  All areas of healthcare have been impacted, including the patient’s financial responsibility for healthcare services in the form of co-insurance, copays and deductibles. The waiver of a patient’s financial responsibility for healthcare services is regulated by federal and state law. The waiver of co-pays, co-insurance and deductibles has been deemed a violation of the federal Anti-Kickback statue.  A provider who routinely waives the patient’s financial obligation may be violating the participating provider agreement with commercial carriers, state law and federal law with respect to Medicare beneficiaries.  Waiving patient fees is seen as an inducement to the patient to prefer one provider over another for financial reasons. However, The Centers for Medicare and Medicaid Services (CMS) and commercial carriers have been authorized by the federal government to waive patient financial responsibility during the pandemic in order to encourage the public to get treated for COVID-19 and non-COVID medical conditions without fear of a hefty bill.

CMS mandated that all testing for COVID-19 be covered in full by Medicare and private Medicare insurance carriers.  Insurance companies (BCBS, Cigna, Humana, Aetna, United Healthcare) that administer Medicare Advantage plans have also waived patient cost-sharing for services related to COVID-19.  Beneficiaries with a Medicare Part A deductible for hospital treatment and a Part B deductible for outpatient care may be entitled to a waiver for services provided related to COVID-19.  Beneficiaries should review their medical bills for services provided and confirm with Medicare or the Medicare Advantage carrier that the patient cost-sharing amount was waived. Medicare Part B also cover some vaccines (influenza, Hepatitis B) which are not subject to deductible and coinsurance.  Based upon a provision in the CARES Act, when a COVID-19 vaccine is ready for Medicare beneficiaries, no cost sharing under Part B would apply for traditional Medicare and Medicare Advantage plans.

Many commercial insurance carriers have waived patient cost-share responsibility in the form of coinsurance, copays and deductibles. The waivers may include services for COVID-19 testing, telemedicine visits related to COVID-19 and its symptoms, and the waiver of costs to patients for hospital admissions related to COVID-19.

Each individual carrier has specific policy provisions regarding the patient financial responsibility for services provided during the pandemic and services provided for the treatment of COVID-19.  The start and end dates for the waivers vary by carrier, and patients and providers should be aware that the waiver period is subject to change.  Patients should confirm with the doctor’s insurance verification department regarding cost-share responsibility prior to treatment related to COVID-19. Charges for services previously incurred during the pandemic should be reviewed to determine if waiver of patient cost-share responsibility was properly credited to the patient’s account. A refund for incorrect charges previously paid should be explored. COVID-19 testing and treatment should not be a financial burden to Medicare and privately insured patients under current federal guidelines.