COVID-19 Update

Common Ground Healthcare Cooperative Applauds Governor, Legislature for Action on Surprise Bills

Non-profit Health Insurance Cooperative Says COVID-19 Package will Protect Consumers


Common Ground Healthcare Cooperative (CGHC) said provisions of the COVID-19 legislation signed into law this week will protect Wisconsin consumers from receiving surprise medical bills for COVID-19 testing and treatment.

“We applaud the Governor for introducing this idea in his coronavirus package and the legislature for improving it and adopting it as part of their package,” said CGHC CEO Cathy Mahaffey. “People should feel confident when seeking care for COVID-19 that they won’t have to worry about unexpected medical bills coming later from out-of-network providers that may have been involved in their diagnosis or treatment.”

Mahaffey explained that the new law, 2019 Wisconsin Act 185, establishes a Medicare-based benchmark for the payment of COVID-19 testing and treatment and requires insurers to use that benchmark to reimburse out-of-network medical providers. The legislation also prohibits health care providers from billing patients for more than the benchmark when a service, treatment, or supplies are related to the treatment of or testing for COVID-19.

These protections are already in place for in-network care through insurance company contracts.

“Simply put, it means that a patient will not receive a surprise bill when he or she is required to go to a non-network hospital due to capacity issues during the pandemic,” she said. “There will be no disagreements over payment for testing and treatment, and no patients stuck in the middle.”

Mahaffey said that CGHC has long advocated for a surprise billing solution based on a benchmark rate of payment for out-of-network care, but the issue took on more urgency with COVID-19. “As we explained to legislative leaders, we all need to work together right now for good of Wisconsin families and those who care for them,” she said. “That means insurers might have to pay a little more than they would otherwise, and providers need to accept that as payment in full.”

Congress has been working on a surprise billing fix at the federal level for several months, even before COVID-19 came into the picture, but they have not been able to come to agreement. “Congress should follow Wisconsin’s model and establish a Medicare benchmark. It’s open, transparent, and one of the easiest things we can do to simplify health care and protect consumers who have lost confidence in our country’s health care system,” said Mahaffey.