A new study has shown that many patients who have been hospitalized with COVID19 in 2020 have paid up to $4000 from their own pocket, even after many insurance firms have implemented waivers for treatment linked to COVID19. Experts who have been involved in the study have said that when the pandemic has hit the United States last year, insurance firms have waived off most of the medical costs for treatment related to COVID19. Experts have said that the decision has been a show of goodwill towards the customers and to dodge health care premium rebates ordered by Obamacare. However, a team of experts from the University of Michigan has found that not all waivers have been all-inclusive. Experts have said that it means patients who have been privately insured have paid more than $4000 out of their own pockets for their hospital bills. Patients who have been covered under Medicare have ended up paying nearly $1500 from their own pockets. The authors of the study have collected data from 7.7 million patients who have been insured by private insurance firms. They as well have studied the data from 1.1 million people who have been covered under Medicare Advantage Plans. Experts have found that slightly more than 4000 patients have been admitted to hospitals after testing positive for the SARS-CoV-2 virus at some point of time from March to September 2020. As per the study, nearly 981 patients or 71.2 percent of patients out of 1377 patients who have had private insurances have paid an average of $788 from their own pockets for medical bills. However, around 5 percent of such patients with private insurances have been given a huge bill for facility services with an average of $3840 in out-of-pocket costs. Nearly two percent of patients with private insurances have paid $4000 out of their own pockets for facility costs.
Experts who have been involved in the study have said that facility services consist of lab services, accommodation in hospitals, and pharmacy services. They have claimed that these are some of the most costly services that are covered within the out-of-pocket waivers for a huge part of insurance plans. The authors of the study have noted that if the lack of out-of-pocket costs for facility services is a sign of the existence of an insurer cost-sharing waiver for these services, the majority of hospitalizations in the study covered by insurers have had waived off cost-sharing for facility services. If this assumption is true, a higher number of out-of-pocket costs for professional and ancillary services shows that cost-sharing waivers by many insurers might have not been able to cover costs for care linked to hospital admissions. Experts have said that professional and ancillary service charges that patients have faced include ambulance use, services offered by clinicians, and other claims like the use of medical machinery. Health experts have said that since the waivers have been applied by private insurers rather than being ordered by the US government, they are not supposed to be all-inclusive. On the other hand, the authors of the study have not been able to determine if the waivers have been intentionally non-inclusive or not. They have said that it is uncertain whether the failure to offer an all-inclusive waiver has been intentional. Other than COVID19 testing and vaccination, there is no mandate from the US government for insurers to wave off cost-sharing for hospital admissions linked to COVID19. Therefore, waivers offered by insurers might be heterogeneous. Waivers from some insurers apply to facility services. While other waivers offered by insurers apply to care linked to hospital admissions more widely.
The authors of the study have said that some out-of-pocket charges that have been paid by patients might be due to some administrative faults. They have said that even if insurers have wanted to offer waivers to cover all care linked to hospital admissions, execution issues might have taken place. Health experts have said that patients might have been billed wrongly if insurers fail to link clinician inpatient evaluation and management bills to the COVID19 hospitalization. The authors of the new report have said that patients who have been covered by Medicare Advantage Plans have paid less. However, some patients have paid out of their own pockets even after getting the cost waivers. Among those who have faced out-of-pocket costs, the majority of them have paid nearly an average of $277 when they have been billed by clinicians. As far as hospital bill goes, they have paid an average of $1536 and 0.2 percent of patients have paid more than $4000. Health officials have said that these waivers have come into existence in the early stage of the pandemic and they have served a few jobs for insurance firms. They have said that earlier, the move has come as a good deed when the lives of millions of people have been in high danger. Then, waivers have helped increase the amount; the insurance firms have been paying for medical losses. The 2010 law known as Obamacare has become a part of the Affordable Care Act as well as a provision that insurance firms must invest at least 80 percent of their earned revenue via premiums on medical expenditure. The law says that if any insurance firm falls short of any amount of 80 percent, it needs to pay back to customers via insurance rebates. Experts have said that the law has been implemented to make sure that insurers do not force exceptionally high premium costs and start spending a majority of amounts on internal managerial costs. However, insurance firms still have not been able to reach the 80 percent mark even after offering waivers. They have $2.1 billion in rebates that have been owed to customers after the last year. The authors of the study have pointed out that these waivers have dramatically vanished this year. Patients who have been admitted to hospitals in the later stage of the pandemic have paid thousands for out-of-pocket costs to seek treatment for COVID19. The findings of the study have shown that if insurers agree to end cost-sharing waivers, the out-of-pocket cost for COVID19 related hospital admissions might be large.