The cost of a hospitalization related to COVID-19 can be high. Patients may be admitted to intensive care units and require mechanical ventilation, with some patients requiring a ventilator for more than two weeks. For out-of-network hospitals, there is no agreement that sets forth the reimbursement rates the hospital will be paid for providing this care.
Under the Coronavirus Aid, Relief, and Economic Security Act, providers who receive CARES Act grants are barred from charging out-of-network patients more than what the patient would pay to receive care from an in-network provider. While this provides guidance on how much a patient may have to pay for receiving COVID-19 care at an out-of-network hospital, the CARES Act says nothing about how much the patient’s health plan should pay the hospital.
Without such guidance, health plans and out-of-network hospitals may find themselves disagreeing on the appropriate payment for care related to COVID-19. In this Law360 article, Matt List looks at the extent to which hospitals’ charges and costs for care related to COVID-19 may vary by using data from the Centers for Medicare & Medicaid Services.
EDM: Merger specificity or alternative reality
In this article published in the December 2021 issue of the ABA Antitrust Magazine Online, Gopal Das Varma addresses two questions related to the pricing...