The major insurers are acting in good faith in that they are moving to waive member cost sharing for COVID-19 testing.
BREAKING: tonight @UnitedHealthGrp joins @Cigna and @Aetna and several Blue Cross plans waiving #COVID19 cost-sharing. Self-insured employer plans they administer will likely follow as more firms take measures to contain outbreak. $UNH https://t.co/qn9TfICXjv
— Bertha Coombs (@berthacoombs) March 7, 2020
All Blues are waiving the cost sharing.
This is a needed step so that testing and treatment do not face cost barriers.
But this is only on the consumer-insurer cost-sharing interactions. No cost-sharing on needed testing effectively makes the demand curve nearly vertical.
However, it is an incomplete step as these actions are not addressing the insurer-provider contractual relationships of in network or out of network charges. OON charges lead to balance billing opportunities. Balance bills consist of the difference in what an OON provider charges and what an insurer pays. That increment can be sent to the patient. Not all OON provider groups will balance bill but some do and may.
The Health Care Cost Institute (HCCI) examined out of network (OON) billing for commercial groups last year. They found different prevalence of OON billing that varied by geography and specialty. OON billing is an opportunity for a provider group to engage in balance billing and therefore the creation of surprise bills. I want to examine specialty.
From their data, the most common specialty to have an OON bill is an independent lab. The second most common Emergency Medicine.
COVID-19 requires a lot of testing. Some people will be using lots of emergency services provided by EM docs.
We should expect a significant amount of testing and ED services to be provided by OON providers.
Some of them will be reasonable decent actors. Others will have a strong incentive to balance bill and hope that they can get to the airport before either a mob with pitchfork and hot torches or the FBI can reach them.