Even With Public Health Emergency Extended, Providers Can’t Relax About Denials

On October 2nd, US Secretary of Health and Human Services (HHS) Alex Azar extended the public health emergency (PHE) due to COVID-19 for another 90 days beyond the previous expiration date of October 23rd. By doing so, he extended the various waivers and flexibilities granted to healthcare providers by the Centers for Medicare and Medicaid Services (CMS), including the Medicaid waivers granted to states like Maryland, which are linked to the PHE.

Private health insurers, however, are free to set their own waivers without reference to the PHE. Indeed, some payers that originally adopted the end of the PHE as the expiration date of their waivers have now set a fixed calendar date, meaning that their waivers will lapse before the PHE does. For example, United Healthcare (UHC) previously stated that its cost-sharing waivers for COVID-19 treatment would expire at the end of the PHE for its individual and group health plans and on December 31st for its Medicare Advantage plans. On October 7th, UHC quietly updated its guidance to indicate that the cost-share waiver for COVID-19 treatment will expire on December 31st for individual and group health plans and will only apply to in-network visits between October 23rd and December 31st.

This reinforces the point we made a few weeks ago, when we wrote that it’s important for providers to be skeptical when payers make promises about covering COVID-related care. Many of the policies are specific to patient responsibility but make no mention of provider reimbursement, while other policies may apply only to certain types of plans or to in-network providers. Despite a lot of “we’re all in this together” rhetoric from payers, the reality is that they continue to deny COVID claims and make providers jump through hoops in order to get paid.

At HLS, we are keeping up the pressure on payers and making sure that their denials don’t go unchallenged. If you are having trouble getting your claims paid and don’t have the resources to appeal in-house, HLS can help you out. Contact us and we’ll find a solution for your denial problems.