Even though the COVID-19 vaccine is rolling out in Ohio, hospitals are still nearing capacity because the daily case count remains high. In this edition of OH Really?, we ask who pays for that treatment – and how it could impact future health care costs.
Listener Vincent Winslow from Beachwood wants to know if insurance pays for coronavirus treatment.
We put the question to health finance expert J.B. Silvers, a professor of health finance at Case Western Reserve University's Weatherhead School of Management. He says insurance companies do pick up much of the cost.
A: There is some incremental coverage from CARES dollars, but primarily your insurance company gets billed for what you do. There are a few new codes that are put out there that you can get paid extra for some things that are specially just for COVID.
The anomaly is that their total cost of care -- their total claims -- has gone down, not up, this year. The reason is people haven't gone in to have service, to have things done to them. The amount of elective surgery is way down for the year, and so they saved money on normal care and spent more on COVID care for a smaller population.
Q: So once things get 'back to normal,' should we expect a rush of people coming in for non-essential procedures?
A: Well, everybody would like to know the answer to that one. This is a time period where you have to be a little sympathetic with the actuaries who try to guess that. So far that hasn't happened. The service levels have come back closer to where they were before COVID hit, but they haven't jumped way higher than that. So for next year, insurance premiums are very level. There's not seen a big jump in any of them.
Increasing premiums?
Q: Then in 2023 or 2024, do you think we'll see an increase in premiums?
A: That's a very good question. Part of the speculation is that with a lot of Telehealth services, moving service into the home, doing distant things, that we have fundamentally changed the way we take care of people. And that's not going to go away.
People in many cases actually like the kind of service they're getting. And it's significantly less expensive and more convenient for a lot of people; so they're going to want to continue with some of it. Things that we used to go into a facility to do, we're now doing remotely. That's a lot less money. And some of the things that we did that maybe we didn't really need to do -- extra tests and things of that sort -- maybe that will continue on.
The speculation is that we're sort of at an inflection point, in terms of care. And the way we do things in the future won't be the same as what we did in the past. You can't just do a straight line extrapolation.
Case counts and funding
Q: We've gotten a separate question, anonymously, asking if hospitals are just padding the number of coronavirus cases -- and even adding in flu cases -- because they somehow get more money from insurance companies?
A: That is not the case. You have primary and secondary diagnoses for everything that gets done. And the primary diagnosis is for example, a heart attack or something like that. It may have a secondary diagnosis of COVID that made that heart attack happen faster; or chronic obstructive disease may make it worse. So that will still get coded as COVID, even though that's not the primary reason why people have died.
So, the number of case counts we're getting are accurate; I'm pretty sure of that. We're not having that padded just to get more money -- fundamentally, because that doesn't buy anything more. You're in there for heart disease or COPD and that's what's driving the payment. But coding for the secondary is something that we look at because it probably helps exacerbate that and make it happen faster than would've otherwise. So it's a very important factor, but people aren't making this up; you just don't make it up.
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