Arriving at higher gear prices, doctors want insurers to pay

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SACRAMENTO: The treatment of patients has become more expensive during the pandemic and doctors and dentists do not want to be stuck by all 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 office in Stockton. .

His practice used to depend on surgical masks that cost 20 cents each, but which has been upgraded to N95 masks at $ 2.50 for savings. In addition, his office schedules two or three fewer patients each day to accommodate physical distancing and give staff members time to disinfect among patients, he said.

“We’ve borne a lot of financial costs,” Tippett-Whyte said. “We shouldn’t bear the cost of that for ourselves.”

His argument raises a fundamental covid question: who should pay for pandemic expenses? Should healthcare providers be the new pandemic-era protocols or insurance companies that could pass on their additional costs to customers in the form of higher premiums?

California doctors and dentists lobbies say insurance companies are covered in cash after collecting premiums during the pandemic, but that they have paid fewer claims than usual and should pay the bill. The California Medical Association, which represents physicians, has sponsored legislation that would require insurers to reimburse medical and dental practices for pandemic-related expenses, such as personal protective equipment, disinfectant, and time to examine patients. symptoms of patients before an appointment.

The doctors’ request to bill Medicaid and Medicare supplies and other pandemic-related costs recently failed at the federal level. But in Washington state, a new law sponsored by the state doctors ’lobby requires private health insurers to reimburse some of those costs.

Commercial insurance groups have opposed the two state measures.

Reimbursement of the cost of non-medical supplies is not usually the responsibility of insurers, said Mary Ellen Grant, a spokeswoman for the California Association of Health Plans.

“Here we are with treatment and office levels at pre-pandemic levels. They now want an additional payment from the plans to pay for non-medical expenses,” Grant said.

The insurance industry also notes that doctors and dentists have not had to fend for themselves in terms of PPE and other pandemic-related expenses. Since April 2020, the U.S. Department of Health and Human Services has distributed $ 9.9 billion to more than 50,000 California medical providers through the Provider Relief Fund, of the $ 178 billion available nationwide.

And more than 900,000 companies in the “health care and social care” category, including some medical practices and dentists, have been getting loans from the Small Business Administration Payroll Protection Program since March 2020.

A letter from insurance groups opposing the California bill points to other aid, such as prepayments of federal government insurance claims and state-based insurance plans, grants and loans, and programs that distributed free PPE to some practices.

“They’ve received a lot of help from the feds to cover those costs,” Grant said.

Health insurance companies saw their margins and profits skyrocket at the start of the pandemic when they collected premiums while patients postponed non-urgent medical care. These were reduced when people started going back to the doctor. However, the nation’s largest medical group, UnitedHealth Group, recently announced that its net profit for the first quarter of 2021 was 44% higher than in the same quarter last year.

Allison Hoffman, a professor of health policy research at the University of Pennsylvania’s law school, said she has little sympathy for health insurance companies that “made a fortune over the past year” by collecting premiums without paying the number. typical of treatments and doctors. visits.

“We’re starting to see a kind of broader definition of what health insurance could pay to keep people healthy,” Hoffman said. “There’s nothing like a public health emergency that sheds light on the fact that sometimes it’s not a prescription drug or a surgical procedure that will improve health.”

Late last year, the American Medical Association pressed the Federal Centers for Medicare and Medicaid Services to approve a code of procedure that doctors could use to bill these public PPE insurance programs, disinfection materials, office modifications to keep people separate, and staff time dedicated to instructing patients before their visits and checking for their symptoms. Often, when federal regulators approve a new billing code for Medicare and Medicaid, private insurers also begin reimbursing the corresponding costs.

Allowing doctors to bill this code would help them follow infection control protocols without reducing revenue, the association said. he wrote to the federal agency.

But CMS denied the request, saying it considers paying those costs to be part of paying the rest of the appointment, according to an agency spokesman.

Following this decision, two state medical associations took over the cause themselves.

The Washington State Medical Association supported Law, which went into effect on April 16, allowing health care providers to bill state-regulated private insurance companies for $ 6.57 when they see a patient in person (in addition to billing for services). to provide) to cover the cost of an additional PPE, staff time, and materials to conduct and transport covide tests. The new rules persist in the rest of the federally declared public health emergencies.

For a law that placed the state medical association and insurance association on opposite sides of the negotiating table, it was extraordinarily unquestionable, said state Sen. David Frockt (D-Seattle), who introduced the bill.

California legislation, which is still being debated, is more open than Washington legislation.

SB 242 it does not specify a dollar amount, but would require state-regulated private health plans to reimburse dental and medical practices for “medically necessary” business expenses associated with a public health emergency.

The California Medical Association said medical practice revenues fell by a third, while PPE costs rose 14% in the first six months of the pandemic, according to a October 2020 survey its members. Of those surveyed, 87% said they were concerned about their financial viability.

“When you look at the record profits of some of these listed companies and what they show their shareholders, that would be a drop,” association spokesman Anthony York said of health insurers. “It doesn’t surprise us that the plans don’t want to pay more, but ultimately this is a fight we will have in the legislature.”

The bill is intended to prevent small and medium-sized practices from closing their doors in the face of rising costs, said its author, State Sen. Josh Newman (D-Fullerton). State medical and dental associations warn that anything that adds costs and cuts revenue could force the closure or consolidation of minor practices, which would aggravate the shortage of doctors and dentists across the state.

“What I’m doing, as a legislator, is deliberately offsetting some of these heavy costs so we don’t lose doctors and surgeries,” Newman said. “It would be a shame for these communities to lose access to health care.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.





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