University of Michigan law professor Nicholas Bagley and I outlined some significant potential cost barriers to care for COVID19 (and implicitly everything else) in the New York Times yesterday:
A patient with insurance through work or the health-insurance exchanges can be surprise-billed when she seeks medical care at a hospital or clinic that’s in her insurance “network” — but then receives medical care from a person or an institution that’s outside the network.
That out-of-network provider will first send a bill to the patient’s insurer. But if the insurer doesn’t pay the full amount, the provider may bill the patient directly for the remaining balance. Because the provider is basically free to name its own price, these surprise bills can be wildly inflated…
In a coronavirus pandemic, a patient can do everything right and still face substantial surprise bills. Take someone who fears that she may have contracted Covid-19. After self-quarantining for a week, she develops severe shortness of breath. Her partner rushes her to the nearest in-network emergency room. But she’s actually seen by an out-of-network doctor — who may soon send her a hefty bill for the visit.
The ACA provides some protection for in-network billing through a maximum out of pocket limit but that number can be very high. Medicare and Medicaid have strong surprise billing protections while employer insurance regulated by ERISA is the wild west.
We, as a society, need to get people who have medical needs the care that they need. Fear of a surprise bill is a barrier to care. It is not the only barrier, but it is one that is amenable to policy changes instead of requiring both policy changes and the deployment of physical resources. Eliminating the fear of a surprise bill will marginally help.