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How The COVID-19 Relief Bill Will Help Health Care Consumers

Nancy Pelosi speaks to Congress Dec. 21, 2020.
C-SPAN video capture.
House Speaker Nancy Pelosi speaks about some of the provisions in COVID-19 aid package.

Updated 7:55 a.m.

Congress approved a $900 billion COVID-19 relief bill late Monday. The massive bill includes money for stimulus checks, jobless benefits and business loans.

But it also includes protections for health care consumers and money for COVID-19 vaccine distribution, important provisions that could easily be overlooked because of the size of the bill.

Protections Against Surprise Medical Bills

Almost as soon as congressional negotiators reported they’d struck a deal, Democratic House and Senate leaders announced the bill includes a provision to protect patients from surprise medical bills.

Surprise bills are the unexpected charges you can get stuck with when your insurance company refuses bills from out of network providers. Those surprise bills can be quite high—even ruinous—frequently in the thousands or tens of thousands of dollars.

Earlier this year, lawmakers from both parties promised to pass a bill to protect consumers. But then there was intense lobbying by hospital and insurance companies, neither of which wanted to pick up the tab. As recently as two weeks ago, Congressional staffers were saying the protections would not make it into the bill because of all the back-and-forth lobbying.

But negotiators ultimately included it in the bill. It will go into effect in 2022.

It’s a big issue for a lot of Americans. A Kaiser Family Foundation survey of large employer plans revealed that 18% of all emergency room visits and 16% of in-network hospital stays resulted in a surprise bill for their employees.

The federal measure will supplement an existing North Carolina law against surprise bills. That law is limited. It doesn’t protect some people with employer-sponsored coverage, and it applies only to surprise bills for emergency services.

The federal law will protect all consumers. And it will protect against surprise bills in non-emergency situations. Here’s an example of how it will work.

Let’s say you need knee-replacement surgery. You go to a doctor who’s in the network covered by your insurance company. And you have the surgery at an in-network hospital.

But then you get a huge bill because it turns out the anesthesiologist wasn’t in the network, even though he works at the hospital. Before the new federal provision, your insurance company probably wouldn’t pay any more than for an in-network anesthesiologist. So you’d be responsible for the difference.

Under the new law, the hospital has to warn you three days in advance of the surgery that you’ll get an out-of-network bill. If it doesn’t, you’re obligated to pay only the in-network amount, and it’s up to the insurance company and the doctor to cover the balance.

Unlike the North Carolina law, the federal bill also protects consumers against large bills from air ambulance services. The National Association of Insurance Commissioners says the average air ambulance trip costs between $12,000 and $25,000 per flight, so those charges can be significant.

Money For COVID-19 Vaccines

The COVID-19 relief bill includes $20 billion for the purchase of COVID-19 vaccines and therapeutics. Lawmakers say that’s enough to make vaccines available at no charge for anyone who needs it.

It also provides $22 billion to states for COVID-19 testing and tracing, and appropriates another $9 billion for vaccine distribution

That will be important for North Carolina. The Department of Health and Human Services told WFAE it will need $86 million through next year to pay for assistance to local health departments, extra nurses, IT support, personal protective equipment, communications even contracts for mobile vaccination efforts.

And while there are no details on how the money will be distributed, given the size of the appropriation, it’s a safe bet North Carolina will get enough to cover its expenses.

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