TDCI Shares New Guidance To Protect Consumers From Balance Billing As They Receive COVID-19 Treatment

Department Shares Guidance to Help Avoid Balance Billing
Friday, April 24, 2020 | 11:23am

NASHVILLE – The Tennessee Department of Commerce and Insurance (TDCI) is sharing new guidance related to helping protect consumers from surprise or “balance billing” related to the costs of treatment for the novel coronavirus (COVID-19).

“During this stressful and unprecedented period, Tennesseans and their loved ones who might be receiving emergency treatment related to COVID-19 should not have to face additional worries related to ‘balance billing’,” said TDCI CommissionerHodgen Mainda. “If Tennesseans who received treatment for COVID-19 discover an instance of ‘balance billing’ related to their treatment from their healthcare provider, I urge them to immediately contact our department and file a complaint.”

“Balance billing” is the practice of a provider billing for the difference between the provider's charge and the health carrier's allowed amount.

The CARES Act, signed by President Trump on March 27, 2020, includes $100billion for healthcare providers. Under the President’s direction, the Department of Health and Human Services will use a portion of that funding to cover providers' costs of delivering COVID-19 care for the uninsured and will send the money to providers through the same mechanism used for testing. As a condition of receiving funds under this program, providers will accept reimbursement at Medicare rates and be prohibited from balance billing the uninsured for the cost of their care.

In an effort to protect Tennessee patients receiving emergency care and/or COVID-19 treatment, effective immediately and for the duration of the public health and civil preparedness emergency declared on March 12, 2020, including any period of extension or renewal:

  • In the event emergency services or COVID-19 testing and treatment services are rendered to an insured by an out-of-network health care provider, such health care provider may bill the health carrier directly and the health carrier may reimburse such health care provider the amount the insured's healthcare plan would pay for such services if rendered by an in-network healthcare provider as payment in full. Health care providers are urged not to additionally bill the insured.
  • Tennessee hospitals, health systems, or hospital-based facilities, or healthcare providers that provide emergency health care services to uninsured patients are urged to only collect from uninsured patients the cost of providing services. For uninsured patients receiving services for the treatment and management of COVID-19, hospitals may collect from the uninsured patients or such patients’ estates the Medicare rate for said services as payment in full.
  • Hospitals, health systems, or hospital-based facilities are urged to refrain from collecting a facility fee of more than the Medicare rate for services received for the treatment and management of COVID-19 by patients who are uninsured.
  • Each hospital, health system or hospital-based facility is urged to maintain fiscal records to identify services provided to uninsured patients for treatment and management of COVID-19 and make such records available for claiming federal reimbursement, as applicable.

A copy of TDCI’s bulletin can be found here.