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This is something I was not aware of so I wanted to share it with you. Beginning in April the State of TN began paying 100% of the cost for COVID-19 testing for anyone wanting a test. The Federal Government required all group health insurance companies to cover COVID testing and treatment under their plans so I am not sure why the state is paying for any and all testing.
This is of course a good thing for all of us to help control the spread through early detection. The state is paying a flat $100 to labs to preform the tests. I am not sure if this includes tests done in a doctors office or Emergency Room but it appears so. All the group insurance carriers we work with are also providing testing at 100% and they are also offering $0 copay telehealth visits for the time being. We work with BlueCross BlueShield of Tennessee, Aetna, Cigna, Humana and United HealthCare. You can find more information about the BlueCross of TN program at www.bcbst.com.
This is of course a very challenging time in our city, state, country and across the world. We are hearing about all the testing and treatment for COVID-19 but there is not a lot of talk about the costs associated with this virus. Supposedly, the government and insurance companies are paying 100% of COVID 19 treatments but we have not been able to confirm that. Fortunately, we have not had very many of our group clients or their employees impacted at this point.
This is the first real study of costs associated with the testing and treatment for COVID-19, unfortunately it does not include Nashville, TN but I am sure the results would be very similar. Key finding are based on several factors:
- The severely of symptoms
- Where care or treatment is received
- The city and state treatment is received
Many individuals have access to telehealth through their employers or health plans. Co-pays for this service range from $0 to $100, though some insurance carriers have waived costs for telehealth visits. Individuals with mild symptoms may be able to have a video visit with a telehealth provider or call a nurse hotline at no cost to rule out the need for further testing. Most of these individuals will be told to self-isolate, rather than come in for an evaluation, incurring no further costs. If they do need further testing, they will likely be directed to a local primary care provider or urgent care center.
If someone with mild symptoms seeks an evaluation with a primary care provider in New York City, their out-of-pocket costs could range from $100 to $450 with an average cost of $235. In contrast, if a person seeks care at a primary care provider in New York City with more severe symptoms, their costs could range from $385 to $2805 with an average of $1220. Although the average costs for a primary care oice visit are highest in San Francisco, lab tests and x-rays are highest in Miami.
If someone with mild to moderate symptoms seeks an evaluation at an urgent care center in New York City their out-of-pocket costs could range from $250 to $514 with an average of $352. However, if a person seeks care at an urgent care center in New York City with more severe symptoms, their costs could range from $535 to $2870 with an average of $1336. Miami and San Francisco have the highest urgent care costs among the included cities.
If someone with mild symptoms seeks an evaluation at an emergency room in New York City, their out-of-pocket costs could range from $506 to $4985 (average $2321). If a person seeks care at an emergency room in New York City with more severe symptoms, their costs could range from $791 to $7341 (average $3305). The average out-of-pocket costs for a visit to an ER for someone with moderate symptoms ranges from $1793 in Seattle to $3997 in Miami.
This is not an attempt to keep anyone from seeking care or treatment if they feel sick, I really wanted to let you see the disparity of costs between providers for the very same procedures.
I wrote a post several months ago that telehealth is where online banking from your cellphone was 10 years ago. People did not understand how it could improve their lives saving time and money. It seems COVID-19 has opened many peoples eyes to the convenience and simplicity of talking to a doctor from your home or office. With the high cost of seeing a doctor along with the amount of time it takes, telehealth can allow providers to see many more patients at a lower cost as well.
There are many convenient care clinics across Tennessee that can diagnose the same basic healthcare issues. Many of these facilities are staffed with nurse practitioners rather than physicians. When you have a telehealth visit you are talking with a licenced doctor who can give you guidance, a treatment plan and call in a prescription if that is deemed necessary.
BlueCross BlueShield of Tennessee "BCBST" is reporting that telehealth visits have grown by nearly 2000% in the past year. Last year from March 16 - April 14 there were 3,900 telehealth visits, this year more than 71,000. We are strongly encouraging our group health insurance administrators to share the word with their staffs about the convenience this service can give them during this challenging time.
Here is the Tennessean article referencing this information.
Employers across Tennessee are making decisions they never would have dreamed of only a few weeks ago as the Corona Virus moves throughout the world. Most want to do the right thing for their employees because they know this is temporary and will want to continue their relationships as soon as things get back to normal. Here is a really good article on different ways TN employers can release their employees from work.
This is go into great detail of what your options are and those of your employees for:
- Remote Work
- Temporary Layoff
- Perminant Layoff
The Novel Coronavirus (COVID-19) pandemic has caused a shift in the way our society operates, forcing businesses to adapt to mandatory closures, less foot-traffic, social distancing, and even quarantines. In these uncertain times, many businesses find themselves unable to keep their employees at work. You may be struggling to understand your options for your business and your workforce. The purpose of this article is to provide you with information about many of your options in these challenging times, to assist you in making informed and intelligent business decisions.
You may hear terms like “furlough,” “layoff,” “separation,” or “termination” used interchangeably to describe your options. These terms may refer to the same thing in a non-union setting, but in a union setting, your labor agreement may define them differently. We want to define these and other terms for the purposes of this article. “Remote work” means that the employees will continue to work from a location other than your office or facility. “Furlough” means that the employee is still expected to work, but with a reduction in hours or days of work. A “temporary layoff” means a temporary, finite or undefined period (depending on the business circumstances) where the employee will be off-duty without pay. With a “temporary layoff,” the employer has the intention of bringing the employee back to work when business circumstances warrant doing so, although depending on how things are structured, that may not be guaranteed. A “permanent layoff” means that the employee is terminated without cause, and there is no intention at the time of bringing the employee back to work.
Apr 2, 2020
Members will not be responsible for any out-of-pocket costs through May 31, 2020
CHATTANOOGA, Tenn. — BlueCross BlueShield of Tennessee will waive all member cost-sharing for COVID-19 treatments, including hospitalizations, through May 31, 2020.
“As part of our mission, our first priority is the health of our members and the communities we serve,” said JD Hickey, M.D., president and CEO. “And since the COVID-19 pandemic is unlike anything our members have faced in recent memory, we want to make sure we remove any barriers to receiving the care they need.”
If a BlueCross member is diagnosed as having COVID-19, they will not have to pay any out-of-pocket costs for testing and treatment administered through in-network providers, including at a doctor’s office, urgent care facility and emergency room, as well as related inpatient hospital stays, through May 31, 2020.
Federal Law Alert
FFCRA: New Rule and Guidance from DOL and IRS
New FFCRA Guidance in Temporary Rule and FAQs
The Department of Labor (DOL) has released rules related to administration of leaves under the Families First Coronavirus Response Act (FFCRA) and answered more common questions on their Questions and Answers page. Below are some key highlights to keep in mind when administering these leaves. We also recommend reading our summary of the FFCRA in Comply if you have not already done so.
Documentation: Employers may not require more documentation from employees than is described below. For instance, employers may not request a doctor’s note or an official notice from a closed school or daycare.
Childcare Provider: The definition of childcare provider includes anyone who generally cares for the children in question. This includes individuals paid to provide childcare, like nannies, au pairs, and babysitters, as well as individuals who provide childcare at no cost and without a license on a regular basis, for example, grandparents, aunts, uncles, or a neighbor.
Reasons for Self-Quarantine: Employees are only eligible for emergency paid sick leave (EPSL) if a health care provider directs or advises them to self-quarantine because the health care provider believes the employee may have COVID-19 or is particularly vulnerable to COVID-19.
EPSL due to Stay-at-Home Orders: In some narrow circumstances, an employee who is subject to a stay-at-home order may be able to receive EPSL. They will only be eligible if the business is open and has work for them to do, but a stay-at-home order that applies specifically to them as an individual prevents them from working. For instance, if the retail store where an employee works as a cashier is still open, but the employee is over 65 and subject to an executive order from their governor that all people over 65 should stay home, they would be eligible for EPSL.
Exempt Healthcare Workers: The exemption for healthcare workers is optional and the DOL encourages employers to be judicious in denying leave (if someone is sick with something that looks like COVID-19, you are encouraged to provide them leave anyway, even if they could be exempted). Healthcare facilities should still post the Employee Rights Poster required by the FFCRA.
Limited Small Employer Exemption: Although this is not new information, we want to reiterate that small employers are only potentially exempt from the childcare leaves provided by EPSL and emergency Family and Medical Leave Act (EFMLA) leave. For instance, one reason for exemption is that providing leave would cause the employer to cease functioning at a minimal capacity. If a single employee asks for intermittent childcare leave one day per week, but can telework the other four days, that is very unlikely to be a financial burden that causes the employer to cease operations. It would therefore be inappropriate (or illegal) for an employer to announce that they will not be considering or granting any childcare leaves.
IRS Guidance on Required Documentation for Leave Tax Credits
Employers have been anxious to find out what kind of documentation they will need to claim a payroll tax credit. The documentation that can be requested of employees is listed below. The IRS has a very helpful overview and FAQ that covers other common questions about the tax credits in detail.
Employers can substantiate eligibility for the sick leave or family leave credits by receiving a written request from the employee that includes the following:
The date or dates for which leave is requested;
A statement of the COVID-19 related reason they are requesting leave and written support for such reason; and
A statement that they are unable to work, including by means of telework, for such reason.
For leave based on a quarantine order or self-quarantine advice, the request should include the name of the governmental entity ordering quarantine or the name of the health care professional advising self-quarantine. If the person subject to quarantine or advised to self-quarantine is not the employee, that person’s name and relation to the employee should be included.
For a leave request based on a school closing or child care provider unavailability, the statement should include the name and age of the child (or children) to be cared for, the name of the school or place of care that has closed, and a representation that no other person will be providing care for the child during the leave. If a child who needs care is 15 or older, the employee must affirm that there are special circumstances (but need not explain them) — the IRS otherwise assumes kids 15 and older can take care of themselves for the length of a workday.
According to the DOL, this is the extent of the documentation you may require.
We have an FFCRA Leave Request Form available in Comply that asks employees for in the information necessary based on their reason for leave.
This information is made available by ThinkHR
April 2, 2020
On March 18, 2020, President Trump signed the Family First Coronavirus Response Act in response to the spread of COVID-19. The Act is an economic stimulus plan that affects coverage for COVID-19 testing and provides expanded federal family and medical leave and a new federal paid sick leave law.
This is brand new and we are awaiting more details. This is the best information I have found so far explaining how it works and how the tax credit to pay for it will work for employers.
There is still time to contribute tax-deductible dollars for 2019 if you are looking for ways to reduce your tax burden. You must have been covered under a qualified High Deductible Health Plan "HDHP" and not be covered under any other health insurance (spouse, Medicare, TriCare). If so, you can contribute up to $3,500 and if you have dependents on your plan up to $7,000. For those over age 55 there is a $1,000 catch up contribution. You can contribute until you file your taxes or April 15th.
If you contributed for last year there are three forms you will need to file your taxes. IRS form 1099-SA shows the amount of money you spent from your HSA during the tax year. IRS form 5498-SA shows the amount of money deposited into your HSA for last year. IRS form 8889 is the form you fill out and submit with your tax return.
Want more information about offering an HSA qualified plan to your employees? Give us a call we would love the opportunity to explain why this strategy works and help lower your group insurance costs and give employees a better way to pay for the medical expenses.
David Moore 615-724-1699
I watched a news story on Channel 5 last night and needless to say was more than a little disappointed in how unfair the story was. It seems they wanted to tell one side only making the big bad insurance company the bad guy again. As a group insurance broker we work with employers and employees trying to manage benefits and costs. One the biggest challenges today is the high cost of prescriptions and all the new specialty prescriptions being prescribed. That is exactly what is happening in this story and Channel 5 makes it sound like the patient is going to go blind because of this new "policy change".
What BlueCross BlueShield of TN is not saying they are not going to cover this medication nor are they going to limit it. All they are doing is requiring members to purchase it through a Specialty Pharmacy where they have some control over the cost of the medication. This story is about Lucentis a shot that treats macular degeration. What they failed to mention is that the medication costs $2,000 per shot.
How much Dr. Awh charges BlueCross of TN for this medication I do not know. Nor, do I know how much the specialty pharmacy charges. I do suspect there is a pretty big difference in cost between the two and while patients and doctors may need to order the prescription the day before the office appointment the goal of BlueCross BlueShield of TN is help control costs and medical spending for all of their members.
I am writing this because we get a lot of calls from frustrated members because the expect their expensive treatments and prescriptions to be immediately covered with no questions asked. For the most part, everyone gets the treatment or prescription the doctor is ordering but I think it's important that the insurance companies do everything they can to make sure that treatment or Rx is necessary since it is saving me and our clients money.
Here are the resources I am using in this post.
One of the biggest claim issues we are now dealing with is our clients getting bills from out of network providers and labs even though they used an in network facility. In the past this rarely happened but it seems some doctors have found out they can make more money by not contracting with an insurance companies PPO network. Even more worrysome is hospitals and out patient surgery centers knowingly allow these providers to work on their patients even though they know the problems it will create.
In the past insurance companies were more tolerant of this abuse and providers thought they had found a loophole to higher reimbursements. Because it became so common, the group insurance companies began following the legal contracts they have in place which allows them to not pay for these procedures as in network benefits. Most policies have a separate deductible for out of network claims which is where these claims get filed. That creates a separate bill for the insured and unfortunately there are no in-network discounts so the provider can bill whatever they want for their services.
Congress and President Trump have promised to create legislation to stop this abusive practice. Of course, they have also promised price transparency and lower prescription costs. We have yet to see those changes and in an election year they need all the Super Pac money they can get.
It is estimated that 20% of all surgeries and hospital stays now have out of network charges with an average cost of $2,011. The scary thing is we are seeing it regardless of which insurance carrier they have and it seems most hospitals are allowing it to happen as well. Even worse, there is very little you can do as a patient on the front end to avoid this from happening.
It is very important for you to understand, this is not the insurance companies fault. This is the hospitals fault loud and clear. They are allowing non contracted doctors to knowingly work on their patients and bill their patients huge amounts they should not owe.
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