Hit by rising equipment prices, doctors and dentists want insurers to pay
Treating patients has become more expensive during the pandemic, and doctors and dentists don’t want to shoulder all of the new costs.
For example, the box of 100 gloves that cost $ 2.39 in February 2020 now costs $ 30, said Dr. Judee Tippett-Whyte, president of the California Dental Association, which has a private dental practice in Stockton.
His practice relied on surgical masks that cost 20 cents each, but switched to N95 masks at $ 2.50 a pop. On top of that, her office schedules two or three fewer patients each day to account for physical distance and give staff members time to disinfect between patients, she said.
“We have suffered a lot of financial costs,” Tippett-Whyte said. “We shouldn’t have to bear the cost for ourselves.”
His argument raises a fundamental question about COVID-19: who should pay the expenses in the event of a pandemic? Is it the healthcare providers struggling with new pandemic-era protocols or the insurance companies that can pass their additional costs on to customers in the form of higher premiums?
California dentist and doctor lobbies say insurance companies are overwhelmed with cash after collecting premiums during the pandemic, but have paid fewer claims than usual – and should foot the bill. The California Medical Association, which represents physicians, sponsored legislation that would require insurers to reimburse medical and dental offices for pandemic-related expenses such as personal protective equipment, disinfectant, and staff time needed to screen patients for symptoms before an appointment.
A request by doctors to bill Medicaid and Medicare for supplies and other costs related to the pandemic recently failed at the federal level. But in Washington state, a new law sponsored by the state’s physician lobby forces private insurers to reimburse some of those costs.
Insurance trade groups opposed both state measures.
Reimbursement for the cost of non-medical supplies is generally not the responsibility of insurers, said Mary Ellen Grant, spokesperson for the California Association of Health Plans.
“Here we are with treatment and office levels at pre-pandemic levels. Now they want extra payment from the plans to pay for non-medical expenses, ”Grant said.
The insurance industry is also emphasizing that doctors and dentists have not had to fend for themselves when it comes to PPE and other pandemic-related expenses. As of April 2020, the US Department of Health and Human Services has distributed $ 9.9 billion to more than 50,000 California medical providers through the Provider Relief Fund, out of $ 178 billion available nationwide.
More than 900,000 businesses in the ‘health care and social assistance’ category – including some medical and dental offices – have obtained loans from the Small Business Administration’s Paycheck Protection Program since March 2020.
A letter from insurance groups opposed to the California bill points to other aid, such as advance payments on insurance claims from federal and insurance plans, state grants and loans, and free PPE distribution programs at certain practices.
“They received a lot of help from the federal government to cover these costs,” Grant said.
An analysis released Monday by the Kaiser Family Foundation found that most health insurance companies have become more profitable during the pandemic. Overall, they collected more premiums from members each month than they paid in claims, and spent a lower premium percentage on medical claims in 2020 compared to 2019. The largest medical insurer in the country country, UnitedHealth Group, recently reported its net income for the first quarter of 2021 was 44% higher than the same quarter last year.
Allison Hoffman, a professor who studies health policy at the University of Pennsylvania School of Law, said she had little sympathy for the health insurance companies that “made their fortunes over the past year. elapsed ”by collecting premiums without paying the typical number of treatments and doctors. visits.
“We’re starting to see some sort of broader definition of what health insurance might pay in order to keep people healthy,” Hoffman said. “There is nothing like a public health emergency to highlight the fact that sometimes it is not a prescription drug or surgery that is going to improve health.”
Late last year, the American Medical Association pressured the Federal Centers for Medicare & Medicaid Services to approve a procedural code that doctors could use to bill these public insurance programs for them. PPE, disinfection equipment, office modifications to separate people, and time spent by staff educating patients. before their visits and check their symptoms. Often, when federal regulators approve a new billing code for Medicare and Medicaid, private insurers also begin to reimburse the corresponding costs.
Allowing doctors to bill this code would help them follow infection control protocols without further reducing their income, the association wrote to the federal agency.
But CMS rejected the request, saying it viewed paying those costs as part of paying for the rest of the appointment, according to a spokesperson for the agency.
Following this decision, two state medical associations themselves took up the case.
The Washington State Medical Association backed a law, which came into effect on April 16, that allows healthcare providers to charge $ 6.57 to state-regulated private insurance companies when ‘they see a patient in person – in addition to billing for the services they provide – to cover the cost of additional PPE, staff time and materials to perform and transport COVID-19 tests. The new rules will last until the remainder of the public health emergency declared by the federal government.
For a law that places the medical association and the state insurance association on opposite sides of the negotiating table, she was remarkably dissatisfied, said Senator David Frockt, D-Seattle, who introduced the law Project.
California’s law, which is still debated, is more open than Washington’s.
SB 242 does not specify a dollar amount, but would require state-regulated private health plans to reimburse dental and physician offices for “medically necessary” business expenses associated with a public health emergency.
According to a survey of its members last October, the California Medical Association said physician office revenues fell by a third, while PPE costs rose 14% in the first six months of the year. pandemic. Of the survey respondents, 87% said they were concerned about their financial viability.
“When you look at the record profits of some of these publicly traded companies and what they are showing their shareholders, that would be a drop in the bucket,” association spokesperson Anthony York told About health insurers. “We’re not surprised that the plans don’t want to pay more, but at the end of the day it’s a fight we’ll have in the Legislature.”
The bill aims to prevent small and medium-sized businesses from closing their doors in the face of rising costs, said its author, Sen. Josh Newman (D-Fullerton). The state’s medical and dental associations warn that anything that adds costs and cuts to revenues could force small practices to close or regroup, exacerbating shortages of doctors and dentists in the state.
“What I’m doing, as a legislator, is deliberately offsetting some of these heavy costs so that we don’t lose physicians and practices,” Newman said. “It would be a shame if these communities lost access to health care.”