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The Cost of Ebola Treatment

Everyone is talking about Ebola, including the risk of contracting it, treatment for those who do contract it, and protection for those who treat patients who have it.  There has been very little discussion, though, about how to pay for the costs of treating Ebola patients, including whether health insurance will cover the treatment and pay the providers.

Most health insurance coverage that complies with the ACA minimum essential coverage standards will cover the costs of medically necessary hospitalization and physician services.  However, many of those policies have significant out of pocket expenses that must be paid by the patient, including deductibles and coinsurance amounts.  There is likely to be an annual cap on the out of pocket expenses (at least in ACA compliant plans), so that may limit the overall amount the patient has to pay.  Also, many policies do not cover, or provide very limited coverage, for care provided outside the country, or for evacuation expenses if you become ill while in another country- so if you are traveling you should check with your insurer and purchase travel health insurance if those expenses would not be covered.

Additionally, given that there is no actual treatment for Ebola itself, other than addressing the symptoms by providing intravenous fluids, balancing electrolytes, and maintaining oxygen and blood pressure, insurers could take the position that the inpatient level of service is not medically necessary (although none have stated this position.)

Furthermore, most insurers  use networks of providers, and either do not cover care out of the network or cover it at a lower rate of reimbursement- and the out of pocket annual limitations are not required to apply to out of network services.  In the event the patient is sent to a non-network facility for treatment, the insurer could classify the services as out of network, and either not cover them at all, or provide coverage that is subject to significantly higher coinsurance, deductibles and potentially limits based on “usual customary and reasonable costs,”  leaving the patient with a very large bill.

Finally, for providers that participate in an insurer’s network, there is generally a contracted rate for services provided.  If a facility has set up a specialized area for treatment of Ebola patients, and needs to provide more than the usual level of staffing for safety reasons, and purchases and uses expensive safety related gear and equipment, it is not clear whether those expenses would be reimbursed by the insurer.  Similarly, the cost of safety equipment for family members would also likely not be covered.

A number of insurers have posted information on their websites about the disease itself and when to get treated.  See, for example, Aetna. Similarly, Kaiser Permanente has lots of information about Ebola and treatment, but the materials mostly address obtaining care and being treated at Kaiser facilities.

Some insurers recommend that covered persons review their policies for coverage information.  See, e.g. Cigna. This may be useful with respect to coverage overseas and for evacuation services, but the policy is not likely to address the other questions discussed above.

The Blue Cross Blue Shield Plans affiliated with Health Care Service Corporation, including Texas, Illinois, Montana, New Mexico and Oklahoma, have information on their websites about Ebola, and indicates that treatment will be covered, including the hospital stay and other treatment, although some of the other issues are not addressed.

Given the fear and concern about this very deadly disease, it would be helpful if more insurers would clearly state their position regarding coverage.