Insurance claims have evolved because of COVID, and insurance companies are using COVID-19 to their advantage.
Impact on insurance claims because of COVID
Coverage for intravenous (IV) administration or prophylactic infusion of an antibiotic, antifungal, antiparasitic or antiviral agent when administered in conjunction with inpatient hospital care can be excluded from insurance claims. This is a result of the US Centers for Disease Control and Prevention’s (CDC) hospital infection measure to reduce central venous catheter-related bloodstream infections, which is commonly referred to as COVID-19. The CDC has measured hospitals based on how well they follow procedures that prevent blood clots from forming around the IV line and from traveling to the heart, lungs or brain.
In addition to insurance claims for IV administration excluded from insurance claims, insurance companies are also asking patients to pay a larger percentage of the total bill in copays and deductibles when receiving an infusion. Insurance companies believe that a medical service is a medical procedure only if it includes one-on-one doctor-patient time, so insurance companies are requiring patients to pay more when receiving infusions without a physician visit.
This insurance strategy does not affect insurance claims for injections, but insurance companies are using this tactic to increase their own revenue.
Insurance Coverage of COVID-19 Testing
As of January 10th, 2022, the Biden-Harris administration created a mandate that requires that insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month. Prior to this mandate insurance companies and health plans could choose whether or not they wanted to cover over-the-counter at-home tests.
The eight (8) free COVID tests per covered individual must be enough for insurance claims for one (1) week of testing, because insurance companies are no longer able to deny insurance coverage by stating that the patient’s symptoms don’t indicate the presence of COVID-19. This insurance mandate does not require insurance companies and insurance plans to cover the cost of any over-the-counter at-home tests for covered individuals after insurance coverage runs out.
The Evolution of COVID-19 and Insurance
As the world continues to move forward through the pandemic, the way things in the medical/legal industry work has begun to change. As we approach the 2-year mark of the pandemic, many health insurance agencies are changing what they cover regarding the COVID-19 pandemic. Below are the insurance changes you can expect to see in your insurance claims.
Some insurance plans, for example, will cover an 18-day hospital stay for COVID-19 testing and treatment. In some cases, you release yourself from the hospital before 18 days, insurance companies will not pay for the insurance claim. You must return to receive medical treatment or be readmitted into the hospital if insurance companies refuse to pay insurance claims.
If you have questions about your Insurance and COVID-19 claims, contact The Mellor Law Firm today. Our insurance legal experts can help you to ensure that your insurance claims are being processed correctly and if not, can help you to fix the situation.