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Corona-meets-surprise billing: Six Things you need to know about this perfect storm

Updated: Sep 6, 2020

by Al Lewis

Yogi Berra said: "It's tough to make predictions, especially about the future." And yet this $11,000 bill for a COVID test came as no surprise to us. The unretouched April blog post below predicted this exact scenario. It's happening everywhere -- but usually undetected, because the out-of-network providers know enough to keep the bills to 4 digits on the theory that while pigs get fed, hogs get slaughtered.

Fortunately, a combination of the Quizzify's surprise bill "prevent consent," along with a bonus for employees using that consent who "out" providers who send massive EOBs, would prevent this from happening.


Here are Six Things you need to know about the Perfect Storm of corona-and-surprise billing. Plus, prominent ERISA attorney Doug Aldeen, uberbroker Rachel Miner, and I just combined to create a new Relentless Health Value podcast hosted by that well-known New York Times celebrity and emcee extraordinaire, Stacey Richter.  If you’d like more info about surprise bills in general, this podcast is where to find it.

We all thought surprise billing was going to be the huge healthcare issue of the year. That was before we knew what the phrase “huge healthcare issue” meant.

The private equity firms that own these out-of-network practices are no doubt relieved that these bills have magically disappeared from the headlines -- but they have not magically disappeared from your claims spend. PE firms have not suddenly decided en masse to become good citizens. Quite the opposite – their other investments are foundering, with out-of-network providers being the bright spots in their portfolio. All thanks to surprise billing.

Here are Six Things you need to know about the Perfect Storm of corona-and-surprise billing.

1. There is zero chance of federal surprise billing legislation this year

Consider the rather sketchy ad campaign run in “swing districts” last year by the private equity firms owning these practices. The theme was that if doctors don’t get paid enough, there won’t be enough doctors.

Well, as effective as that campaign apparently was in 2019 (you don’t see any surprise bill prohibition passed into law, right?), imagine how effective it would be in 2020. All they would need is a few live shots of overwhelmed emergency rooms, which aren’t exactly hard to come by.

Prediction: it’s not just that nothing will pass. You won’t even see a bill make it out of Committee this year.

2. Because your total health spending will drop precipitously in 2020, you won’t carefully parse your bills

Executives pay more attention to healthcare spending – or any budget item – when it is rising. Elective procedures and doctor visits are so far off this year that total spend will decline. Hence you probably won’t even notice these surprise bills.

3. The canary in the coal mine would be employee complaints about surprise bills. Except that the copay is zero in many cases

As an ERISA plan, you don’t have to offer full coverage for treatment. But most of you will follow your carrier’s guidance. Which is to say, you will offer full coverage. Hence employees won’t be balance-billed. And that in turn means they won’t notice the total bill. Or, if they do notice, they won’t care. Bottom line: these bills won’t come to your attention.

4. The majority of corona tests are negative…but there is a catch

Obviously, though, someone showing up at the ER is presumably sick enough to go to the ER even though everyone says (including our coronaquizzes) that the ER is a last resort. Hence, they may very well get treated for something-or-other.

And how do you suppose some providers will code for that treatment? Leaving aside the greed factor, suppose you are a doctor. You’re looking at a patient who is obviously in bad shape. You know that if you code for flu or bronchitis or COPD or whatever, they’ll get a big bill. Whereas if you code for rule-out corona, they won’t get a bill at all. Some nameless, faceless entity (meaning you) will be paying it instead.

It doesn’t help that the complexity of codes somehow related to corona is mind-boggling. It’s not just a corona/no corona situation.

5. What if a corona patient has two diagnoses?

Trivia question: which one do you think will be coded primary the majority of the time, in order for providers to know they will be paid? (See #4…and link to this coding guide.)

6. Fortunately, because most surprise bills in the near future will be emergencies, there is an easy solution

The solution you are about to read works only in emergencies. But these days, that category covers most admissions and transfers…and virtually every ER visit.

Just make sure employees carry this card. Once they show the card and sign the card, neither they nor you can be overbilled. To learn more about how our “Surprise Bill Prevent Consent” works, both the New York Times and Linkedin have carried stories about its successful use. The “back story” of how we invented it (with assists to Marty Makary, Marilyn Bartlett and David Contorno) can be found here.

You can get these consent cards from us free, in quantities for your own use – send a stamped envelope to 37 Pennsylvania Avenue, Newton MA 02464. (If you want more than a handful, please throw in a few bucks.) Or you can order them in bulk on your own.

We can also send you some clear tape, with the consent on it, to paste onto your insurance card:

You can also download paper copies in bulk:

As if that weren’t enough, you can drop these consents right into your Apple Wallet, along with our other medical visit cheat sheets:

How do you get employees to use these consents? You could make 100% coverage dependent on using them. (High-deductible health plan rules have been suspended for corona.)

Employees won’t magically understand the consequences of surprise billing, but that’s addressed by Quizzify surprise billing quiz module.

The bottom line: it will almost certainly cost you much less to cover these treatments at 100%, using these free consents, than standard coverage would cost you.


Quizzify provides the education employees need to be health-literate, wiser and more confident healthcare consumers

Teach employees how to navigate the ins and outs of their health benefits and gain valuable information about better health practices. With quizzes reviewed by doctors at Harvard Medical School, Quizzify helps employees live healthier lives and save money on healthcare... without collecting any private health information.

Benefits are of no value if employees don’t use them. You can customize Quizzify so that your quiz questions can explain exactly what the value is...and our “learn more” links can point employees to exactly where they need to go.


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