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Virtual Health is Saving Lives During Coronavirus

How Virtual Health Services are Saving Lives During the Coronavirus Crisis

With the outbreak of COVID-19 healthcare workers and providers have had to come up with better ways to diagnose and treat patients. The number of patients who need to be seen for health issues both related to and peripheral to the coronavirus has put a strain on our hospitals.  It is in this environment that Telemedicine has found its spotlight. Telemedicine or Virtual Health Care is the practice of performing virtual appointments and check-ups for patients. Especially now, this keeps both patients and healthcare workers safe while continuing to provide care for those in need. This is only the beginning of how virtual health is saving lives during the Coronavirus pandemic.

Virtual healthcare has slowly been taking hold as more and more of the norm in recent years. The cost savings alone make virtual care the right choice for many doctors, hospitals, and patients.  $7 billion of physicians’ time can be saved by switching in-person visits to virtual appointments.

These days, in quarantine, many people need the ability to have their doctor’s appointments at home. Even during the best of times, for many, the convenience is key to successful follow up appointments and check-ins.  Telemedicine allows for a safe environment to ask questions, get simple diagnoses and to get prescriptions from your doctor while remaining at home.  

Doctors around the country have implemented telemedicine and online appointments to help keep all patients safe from COVID-19. Patients with a smartphone or computer can visit a provider in a secure network. Dr. Chris Davis, Medical Director for UCHealth’s Virtual Urgent Care says, “COVID-19 is quite infectious, so if you can stay home and get medical advice, that gives you two advantages. First, if you’re sick, you’re not going to be bringing your illness into a doctor’s office or a hospital. Second, you won’t be exposed to other patients.”

These changes to what we have thought of as normal healthcare have given people affordable, manageable options to care for themselves and others throughout this uncertain time. As we work to navigate COVID-19, the best thing we can do is keep ourselves and others safe from harm by ensuring we do everything we can to stop the spread.

Insurance Coverage and Coronavirus Testing

Will My Insurance Cover the Cost of Coronavirus Testing?

As we continue to navigate through the effects of COVID-19, many questions arise when it comes to insurance coverage. Does your specific insurance cover testing? Does it cover treatment? How can I find out my coverage options? 

The short answer is it depends on your coverage. Health insurance coverage varies widely, depending on where you live and how you obtain your coverage. Almost half of Americans receive their insurance coverage from their employers. Those plans are managed by both the federal and state guidelines, which depend on the group size and whether or not the plans are self-insured or fully-insured. So how does Coronavirus coverage fit into these health plans?

Let’s begin with testing. The Families First Coronavirus Response Act states the Medicare, Medicaid, and private health insurance plans are required to cover the cost of Coronavirus testing, without cost-sharing or pre-authorization requirements. This is including lab service costs and provider fees at doctor’s offices, urgent care clinics, and emergency rooms where tests are given. Because this act is federal law, self-insured and fully-insured plans apply to this rule. However, the testing coverage requirements that are imposed on some states are only applicable to fully-insured plans.

Plans that are not considered minimum essential coverage, for example short-term health plans, fixed indemnity plans, and healthcare sharing ministry plans, are not required to cover COVID-19 testing. Some of these plans do volunteer to cover COVID-19 testing, so look to your plan for specifics.

Some states, like Washington, have extended their testing coverage requirements to include these short-term plans, but most states have not imposed further requirements for these plans.

If you are uninsured, states can use their Medicaid programs to cover COVID-19 testing to cover their uninsured residents. There is $1 billion in federal funding to reimburse providers to cover COVID-19 testing for uninsured patients.

Now, let’s get into treatment coverage. As of right now, there is no specific treatment for COVID-19, most people will not need treatment, but around 20% of patients will be hospitalized, and 20% of those patients will need intensive care. This inpatient care is considered an essential health benefit for all ACA-compliant individual and small group health plans. Large group plans are technically not required to cover essential health benefits, but they are required to provide “substantial” coverage for inpatient care.

Even with coverage, inpatient care is expensive. The ACA states that all non-grandfathered/grandmothered plans must have in-network out-of-pocket maximums that can reach up to $8,150 for a single individual. Most COVID-19 treatment costs will not exceed this amount, but many health plans out-of-pocket limits are below that amount. Which leaves patients that need hospitalization with a four-figure invoice.

Some states, like New Mexico and Massachusetts have required state-regulated insurers to cover treatment and testing without cost-sharing. Minnesota is encouraging their providers to do the same. 

Most states are both encouraging and requiring state-regulated providers to allow testing and treatment as in-network, whether or not the medical providers are in the plan’s network. Patients may still be subject to balance billing because out-of-network providers do not need to accept the payment as payment-in-full.

Here are some ways to ensure that you are protected during these uncertain times:

  • If you are uninsured there is a COVID-19 special enrollment period in some states. If your state is included, an ACA-compliant plan is a great option. If you have a low income, you could also be eligible for Medicaid.
  • If you currently have health insurance, understand what your plan covers, and how your cost-sharing responsibilities for in-patient and out-patient care may apply.
  • Look at your health plan to see how it handles prior authorizations.
  • Look at the details of your health plan’s provider network. If you see in-network providers you have a better chance of avoiding balance billing.
  • Check to see if telehealth is covered, for less-severe cases, this is the best way to help prevent the spread of COVID-19. Some health plans are eliminating or reducing cost-sharing for telehealth services.
  • If you have an HSA-qualified plan, you can devote your pre-tax money to your account for the year. The money you contribute to your plan is able to be withdrawn tax-free for out-of-pocket health care expenses.

How Coronavirus is Affecting Healthcare Costs

Coronavirus has disrupted quite a few industries over the last few months. One of the industries that it will continue to affect for the foreseeable future is the healthcare system. As it continues to spread, and we continue to see the effects of coronavirus, insurance programs will likely see a rise in health care costs. Here is an overview of how we think coronavirus could affect health care costs:

The first place we will likely see a rise in healthcare costs is with testing and treatment. As the number of coronavirus cases is still unknown and potentially growing, public health will be vital to limiting and eliminating the spread of coronavirus. There are mixed messages on whether or not we have reached the peak number of cases in the U.S, and some say that there may be another spike in cases shortly if social distancing is relaxed. 

The cure for coronavirus is still unknown, but the usage of current treatments are a way to support those who are infected. Once an effective treatment is established, there will likely be a reduction of strain on healthcare systems. Still, additional costs of implementing new drug treatments will cause the overall cost of care to increase along with a new vaccine treatment as an added cost in the near future. 

Around 15% of people infected with coronavirus require some kind of hospitalization, which typically includes needing ventilation. Costs associated with these procedures can be extremely expensive. Ventilation treatments can cost anywhere from $34,223 to $88,1114, depending on how long a person is on the ventilator. 

Many healthcare providers are concerned about the possibility of seeing an influx in people using healthcare services after stay-at-home orders lift. It is likely that the low demand for healthcare now will cause a delayed demand that could be overwhelming for providers and insurance companies later down the road. This sudden influx could quickly drain hospital resources if they are not adequately prepared. In some parts of the country, hospitals could not have enough beds for the number of patients needing care.

Hospitals have already begun canceling elective procedures. Though they are considered elective and therefore not urgent, these procedures almost always improve the patient’s daily life and prevent early death. These delayed procedures will likely be scheduled for next year, which would raise overall healthcare costs for 2021. Foregoing these procedures could also cause health outcomes to decline, as well as higher spending for the individual later due to complications. 

Medicare

Because the older populations are at high risk for contracting COVID-19 and potentially having complications related to coronavirus, the Medicare program could be affected. An increase in Medicare spending could potentially spill-over into the beneficiaries’ out-of-pocket spending in years to come. The out-of-pocket expenses will show up as an increase in premiums, deductibles, and other cost-sharing programs. 

Another consideration that may affect Medicare spending is telehealth services. Under the CARES Act restrictions on telehealth services, which could cause a decline in doctor’s office visits and the costs associated with holding in-person appointments.

Medicaid

Medicaid programs will also likely be affected by COVID-19. The costs of the program will likely increase as unemployment increases, and people are losing coverage provided by their jobs. Medicaid spending and enrollment increases in times of economic downturn. As more people enroll and the costs dealing with testing and treatment increase, the pressure on Medicaid costs will also increase.

As we continue to understand the effects of coronavirus, there are many implications to consider. Contact us to get the right coverage for you and your company.

Coronavirus Testing: Who Should Pay?

COVID-19 Testing is Essential to Slow the Spread: Who Should Pay?

Coronavirus has spread rapidly throughout the world, especially in places with more vulnerable populations. Specifically, in the nursing homes, there has been a massive spike in COVID-19 related deaths. With this information, many state officials have called for nursing home workers and residents to be tested consistently. These health care workers are some of the most underpaid workers in the industry, yet they might have to take on the financial burden of paying for their weekly testing. 

Regular testing of these workers is important to help control the spread of Coronavirus, as they may be in contact with COVID-19 carriers daily. The initial outbreak of the virus occurred in a nursing home in Seattle, and has seen a large death toll in nursing homes in both New York and New Jersey. 

State by state there has been various information being relayed, which makes it confusing for workers who are unaware if their insurance will cover the cost of the testing. Federally, the CMS states that nursing homes should be tested weekly, while the CDC said each facility can adjust their testing frequency depending on the presence of COVID-19. 

Testing all nursing home workers and the residents would add up to 150,000 tests per day. With tests costing around $100, this would be a large undertaking for whoever takes the cost. 

Because nursing home workers are the lowest paid health care workers in the industry, it is likely that many of them don’t have insurance coverage to help with the costs. These nursing homes also don’t feel as if they can cover the full cost of the tests, they need assistance from the state. 

At SBMA, we offer the best, limited medical coverage in San Diego. Contact us to learn more about how we can help you stay safe during the health crisis.