The department of Health and Human Services included in its terms and conditions for hospitals, clinics and doctors who receive federal emergency funding a clause which bans surprise billing. The clause states that, “for all care for a possible or actual case of COVID-19, the provider will not charge patients any more in out-of-pocket costs than they would have if the provider were in-network, or contracted with their insurance company.” The guidance further states, “HHS broadly views every patient as a possible case of COVID-19.”

Leaving the door open to allow everyone to be viewed as a potential coronavirus patient may not have been the intent of HHS. “Because the terms and conditions do not appear to be sufficiently clarified, there is a concern that there will be legal challenges around the balance-billing provision,” said health policy consultant, Rodney Whitlock.

Balance billing has been a health-care practice for years, allowing the industry broad control on how they bill patients. It is banned in many states, but there is no federal legislation on the matter. Jack Hoadley, a professor of health policy at Georgetown University, said the HHS terms for eligibility to receive CARES-ACT funding could address problems not explicitly sited in the relief legislation like patients billed for testing for COVID-19 when the results come back negative.

“The providers, the insurers, everybody else is going to need clarification, as well as, of course, all of us as potential patients,” Hoadley said. “That’s going to affect our willingness to seek testing or treatment.”

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