The American Hospital Association is calling on the largest private health insurers to expedite payments to providers and ease administrative burden as hospitals across the country face unprecedented financial challenges preparing for an influx of COVID-19 patients.
In a letter to the biggest payers, AHA asked that private insurers allow providers to opt into periodic interim payments, instead of being paid on a claim-by-claim basis, or accelerated payments for the duration of the public health emergency President Donald Trump declared earlier this month.
But payers say their pockets are not bottomless, and they've already taken many concrete steps to help free up time and money for providers as the novel coronavirus continues to spread across the country.
AHA sent the letter Wednesday to top executives of CVS Health, Aetna (which is owned by CVS), Anthem, UnitedHealthcare, Cigna, payer lobby America's Health Insurance Plans and the Blue Cross Blue Shield Association outlining a series of new asks as hospitals scrounge for funds to shore up high-demand resources like personal protective equipment, respirators and ventilators while halting lucrative elective procedures.
Congress allocated $100 billion for hospitals in a sweeping $2 trillion stimulus package to bolster the economy, but its unclear how — or when — HHS will distribute the funds.
In the meantime, the hospital lobby wants private insurers to expedite processing of "billions of dollars" in outstanding claims, scale back administrative processes that can be a time sink for providers and delay payment, including prior authorization, and make sure they provide "adequate" coverage for COVID-19, including covering all cost-sharing for treatment.
Many private payers have taken steps on some of these fronts. And the the trade group for most insurers told Healthcare Dive that they — like hospitals — don't have unlimited funds to combat COVID-19.
"We are working hard to offer billions of dollars of additional resources and enhanced coverage," AHIP SVP of Communications Kristine Grow told Healthcare Dive in response to AHA's requests. "But these resources are not infinite."
In the commercial market alone, COVID-19 costs are expected to be between $34 billion and $251 billion, according to an analysis by actuaries in California's individual insurance marketplace. The high range is more than the total capital and surplus held by the entire health insurance industry in 2018, Grow said, and doesn't factor in costs to Medicare Advantage or Medicaid managed care plans.
Many private payers waived co-payments for COVID-19 diagnostics in a bid to get more Americans tested. Over roughly the past week, Aetna, Humana, Cigna, Anthem and UnitedHealth have all said they will waive cost-sharing for COVID-19 treatment, too, as confirmed cases in the U.S. continue to climb. Still, self-insured plans can opt out.
Many private payers, mirroring changes made in Medicare, have also taken steps to expand telehealth coverage so more patients can see a physician while lessening the risk of exposure. Most have also said they will relax prescription refill limits and lower some prior authorization requirements.