Fee Waivers Are Full of Loopholes, Confusing Language, Exceptions
WASHINGTON, D.C. – While most large health insurers are offering free care for coronavirus patients, their promises are riddled with confusing conditions and loopholes, according to a new report by Public Citizen that analyzed the coronavirus policies of the 25 largest health insurers.
For instance, while 23 of the 25 insurers say they will waive some or all fees for coronavirus treatment, many have rapidly approaching end dates for such waivers. Specifically, 11 of these insurers’ offers are set to expire at the end of May and another four by the end of June. But people still will need treatment; new cases will be significantly higher in June than they are now, according to a Trump administration projection.
Another loophole is that most of the insurers will not pay for out-of-network care. This is insufficient, as the unprecedented circumstances surrounding the pandemic have caused overflowing hospitals in some areas, forcing some patients to seek care from providers outside their network. Only two of the insurers have said they will waive fees for care provided by out-of-network practitioners.
Meanwhile, two large insurers, CareSource and Emblem Health, are not offering any substantive fee waivers for coronavirus treatment.
And Americans in self-insured plans – in which the insurer administers the benefits but the employer pays the claims – may face even more difficulties because free coronavirus care for these plans apply only if the employer opts to offer them. About 60% of Americans who receive health insurance through an employer are in self-insured plans.
Meanwhile, although tens of millions of people have lost their jobs and must figure out how to pay their bills, insurers’ profit margins are increasing because the pandemic is inhibiting people from seeking care for non-COVID conditions.
“Insurers that are swimming in cash are trying to get credit for doing the bare minimum during an unprecedented health crisis, and even those efforts come with caveats, confusing restrictions and premature end dates,” said Eagan Kemp, health care policy advocate for Public Citizen. “Insurers should simply offer free coronavirus treatment to their members for the duration of the pandemic with no confusing loopholes.”
Read the full report here.