Maybe it’s happened to you. Before you make an appointment or visit the emergency room, you check to make sure that the doctor or hospital is in-network under your health plan. Weeks later, an out-of-network doctor involved in your care bills you for the difference between the in-network rate your plan paid and the provider’s usual charge. This is called “balance” or “surprise” billing.
The CARES Act, enacted by Congress on March 27, 2020, prohibits balance billing by certain healthcare providers for COVID-19 related care. The Act establishes a $100 billion Provider Relief Fund for hospitals and other healthcare providers fighting COVID-19. This funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured Americans can get testing and treatment for COVID-19. Hospitals, doctors, and other healthcare providers have to make certain commitments to the government in order to receive these funds.
Congress recognized that, in the current environment, it can be difficult for people to obtain care from an in-network provider and they might have to see an out-of-network provider instead. Accordingly, the CARES Act requires providers to commit that they will not balance bill for care provided to presumptive or actual COVID-19 patients as a condition of receiving relief funds. Even if the provider is out-of-network, they must accept as payment, in full, the rate the patient’s plan would have paid if the provider were in-network.