By Betsy Davis Stone
Right as the COVID-19 pandemic was taking root in the U.S., Governor Andy Beshear signed an Executive Order on March 9, 2020, requiring Kentucky insurance companies to fully cover COVID-19 testing. Nine days later, the federal Families First Coronavirus Relief Act passed, requiring nearly all insurers, including Medicaid, Medicare, and certain private plans that Kentucky can’t regulate, to fully cover COVID-19 testing.
Specifically, the Executive Order and the Families First Act required insurers to waive all cost-sharing including co-payments, coinsurance, and deductibles for testing approved by the Centers for Disease Control and Prevention (CDC).
I’m the Health Law Fellow at Kentucky Equal Justice Center, which means I spend a lot of time keeping up with health policies like this one. And free testing for pretty much everybody sounded great! That is, until we got a bill in the mail for $162.93 for my husband’s COVID-19 test.
I was angry; I mean, free means free, right? Like everybody, we’ve got other stuff we need to pay for right now. For us, that other stuff is medical bills. I’m pregnant, so we’re already paying plenty for things like sonograms and pre-natal appointments and breast pumps…you get the picture.
My husband’s insurance company said they did cover the test, by giving us $51.31 to pay the $162.93 bill with. But paying $111.62 didn’t sound very free to me.
That’s when the insurance company let us know they found a loophole. (An insurance company found a loophole!? I know, I know – you’re shocked.) Even though my husband went to his regular in-network primary care doctor for his COVID-like symptoms, the insurance company told us that his doctor sent the test to an out-of-network lab. The insurance company then balance billed us for the difference between what the lab wanted to charge and what the insurance company wanted to pay.
This type of balance bill is called a surprise medical bill. That’s basically where the insurance company says, “SURPRISE! I bet you never could have guessed that we’d bill you an out-of-network rate when you went to see an in-network provider.”
Surprise medical bills are prohibited in some states, but Kentucky still hasn’t passed a law specifically banning them. However, Kentucky does have a Consumer Protection Act that prohibits businesses from engaging in “unfair, false, misleading, or deceptive acts or practices.”
I don’t know about you, but this whole surprise medical billing business sounds pretty unfair, false, misleading, and deceptive to us.
And to be perfectly honest, my husband’s insurance company messed with the wrong pregnant lady. After explaining the balance bill, the insurance company had the audacity to tell my husband he should have told his doctor what lab to send his COVID-19 test to. Nevermind that his doctor probably sent his test to the only lab within a 300-mile radius processing COVID-19 tests in late March.
This is exactly the type of crazy behavior the Consumer Protection Act is supposed to protect Kentucky consumers against, so I decided to write an appeal to my husband’s insurance company telling them just that. With my husband’s permission, I’m sharing a redacted version here.
If you’d like to use this as a template, here’s a simplified version with instructions on what to write. But first, a few words of advice –
1) As my letter indicates, I’m an attorney, but keep in mind, I’m not your attorney. I don’t know you or your situation, and I’m not giving you legal advice. That said, if something like this happened to you, I’d like to hear about it. My email address is firstname.lastname@example.org. I can’t guarantee that I’ll be able to answer every email, and this is not an offer of representation.
2) If you choose to use this template, replace the brackets with your own information, and delete the bracketed instructions before you send it.
3) Read the letter all the way through before you send it, making sure that you change anything that doesn’t apply to you. You might need to add some details about your particular case.
4) When you got the test matters. Remember that Governor Beshear’s Executive Order was signed on March 9, and the federal Act passed on March 18. If you got a test before those dates, it might not be free.
5) Where you got the test might matter too. This letter is geared toward charges from a test you receive in a healthcare facility, like a doctor’s office or a hospital. According to this new guidance from Kentucky’s Cabinet for Health and Family Services, your test should still be free if you got it at a drive-through site, but you might need to modify the template some if that’s the case.
6) Every insurance company has its own appeal process and requirements. You should pay special attention to what the notices from your insurance company say.
7) Before you file an appeal, call your insurance company unless you’re too close to the appeal deadline and just need to get it done. Being nice to the employee you talk to (sometimes) goes a long way. Try that first. File the appeal if you’re not getting anywhere like us.
8) If you’re mailing your appeal, send it via certified mail. I just went to the post office, handed them my envelope, and told them that I wanted it sent with tracking. However you send it, make a copy for yourself, and be sure you have some record that it got there. For example, if you faxed it, keep the fax confirmation sheet.
Happy appealing! I believe in you, and your voice matters.