National Consumers League applauds Congress for surprise billing protections for consumers

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For immediate release: December 22, 2020

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832

Washington, DC – The National Consumers League welcomes the inclusion of long-needed surprise billing protections in the COVID Relief Omnibus Spending Bill.

Surprise billing happens when a patient’s insurance doesn’t cover a procedure provided by an out-of-network physician, something patients don’t know or realize when they get a procedure. An estimated one in five emergency visits and one in six inpatient admissions will trigger a surprise bill, which can run into the thousands of dollars.

Medical debt disproportionately drives people into bankruptcy. Bill collectors and hospitals often layer on fees, interest, and penalties, driving the original costs way up. A 2019 study published in the American Journal of Public Health found that 530,000 bankruptcies filed annually are because of debt accrued as a result of treatment for medical illness.

This statement is attributable to NCL Executive Director Sally Greenberg:

“We greatly appreciate the bipartisan leadership of Senators Maggie Hassan (D-NH) and Bill Cassidy (R-LA) in getting the surprise billing language over the finish line. We also thank House Energy and Commerce Committee Chairman Frank Pallone, Jr. (D-NJ), Ranking Member Greg Walden (R-OR), Senate Health Committee Chairman Lamar Alexander (R-TN), and Ranking Member Patty Murray (D-WA) for their early leadership on this issue. This is a shining example of working across the aisle for the betterment of consumers.

Consumers can breathe a huge sigh of relief because under the bill—including the cost of an air ambulance—consumers will be ‘held harmless’ when exposed to out-of-network costs. Once this bill is law, consumers can expect that fees charged will be far more affordable and predictable at in-network rates. We are grateful to Congress for recognizing surprise billing as a predatory practice from which consumers need protection. The committee leadership not only helped to pass a bill but launched an investigation.

After two years of debate and discussion on how health care providers and health plans will negotiate these extra costs, it was agreed that patients should be taken out of the middle of dispute resolution processes. Now, we finally have a workable system for protecting consumers.”

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About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Jeanette Contreras portrait

2021 rings in new health care protections for consumers

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By NCL Director of Health Policy Jeanette Contreras

Surprise medical bills occur when patients unknowingly receive care from a provider who is not in their health insurance plan’s network. As the first COVID-19 vaccinations are administered, Congress has passed landmark legislation to ensure consumers needn’t worry about surprise medical bills from emergency medical services.

The passage of this legislation couldn’t come soon enough, as more than 476,000 Americans hospitalized with the coronavirus have already incurred exorbitant medical debt from COVID-19 treatment. Now, thankfully, 2020 will come to a close with renewed optimism in the American health care system.

This new law will also protect consumers from surprise billing from out-of-network ambulance and air ambulance trips, which can amount to tens of thousands of dollars in medical bills. Most patients are conscientious consumers, careful to find a doctor that accepts their insurance before making an appointment. However, in the case of an emergency, a patient faces the possibility of receiving care from an out-of-network doctor in an out-of-network hospital.

As Congress debated legislative fixes to surprise billing, the Administration showed political will toward finding a solution with the issuance of Executive Order 13877, Improving Price and Quality Transparency in American Healthcare to Put Patients First, which includes principles on surprise billing. In a July 2020 report addressing surprise billing, the U.S. Department of Health and Human Services (HHS) further urged Congress to act, recognizing that 41 percent of insured adults nationwide were surprised by a medical bill in the past two years.

Following Executive Order 13877, HHS finalized a set of regulations to address price transparency for consumers. The first rule set to take effect on January 1, 2021, requires hospitals to publicly list standard charges for the items and services that they provide. The second rule, set to take effect in 2022, demands similar transparency from most health plans and issuers of health insurance coverage. These regulations offer consumers more control over their health care spending and better information as they shop and compare health coverage options for themselves and their families.

The new HHS regulations, coupled with the surprise billing legislation, amount to the greatest consumer protections in America’s health care system since the Affordable Care Act. Consumers with health insurance should not have to worry about surprise medical bills—especially during a pandemic. The health care system will be a little more consumer-friendly in 2021, which is good news for all of us.

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COVID-19, what could it cost you?

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Nissa Shaffi

By Nissa Shaffi, NCL Associate Director of Health Policy

As the nation continues to navigate the COVID-19 pandemic, another top-of-mind concern is the cost associated with both testing and treatment for the illness. Between the boldness of certain state officials relaxing restrictions and the rapid ascension of cases, exposure to COVID-19 will inevitably rise.

The reassuring news is that the majority of Americans diagnosed will be able to recover from home. But what if you’re among the 15 percent that will need hospitalization? This subset of the population will require the most acute care, including admission into an intensive care unit and use of a ventilator. Between testing and treatment, there are a lot of factors for the consumer and patient to consider—outright costs of care, as well as cost-sharing (co-pays, deductibles, out-of-network costs, and more)—we did some of the research below.

Testing

  • Affordable Care Act (ACA)-compliant Plans: Under the Families First Coronavirus Response Act, all comprehensive health plans (individual, employer-sponsored, or ACA marketplace plans), must cover testing for COVID-19 at 100 percent.
  • Medicare & Medicaid: Testing is covered at 100 percent for Medicare and Medicaid.
  • Uninsured: Testing will be covered at 100 percent by Medicaid, as mandated by the CARES Act.
  • Non-ACA-Compliant Plans: Testing coverage may vary for consumers with non-ACA-compliant plans (i.e., short-term plans), as these plans are not subject to the protections found in the ACA.

Apart from non-ACA plans, there’s testing done in an emergency room, urgent care, or physician’s office, and all that should be covered. In addition, the health plan cannot impose prior authorization or cost-sharing restrictions (i.e., copays, deductibles, coinsurance) on the patient. Of course, access to testing is currently limited to those with symptoms or those working in health care facilities or other consumer-facing businesses. There are still strict criteria established by the Centers for Disease Control and Prevention (CDC).[1]

Treatment

Newly passed emergency bills do not address coverage of treatment. The Kaiser Family Foundation estimates that out-of-pocket costs for COVID-19 treatment for someone insured on an employer-based health plan could run upwards of $10,000, provided that there are no complications. For patients that require more acute care, costs could reach $20,000.

ACA-Compliant Plans: Health plans are not required to fully cover the cost of positive tests. A majority of the treatments for COVID-19 under ACA-compliant plans will qualify as essential health benefits, and as such will be covered. However, every state defines its own criteria for essential health benefits, and it is possible that some treatments will not be covered, based on where you live. Furthermore, coverage may vary depending on the type of group health plan you have (large vs. small).

Cost-sharing will also likely be imposed. Marketplace plans are required to cap maximum out-of-pocket costs for services covered in-network. In 2020, the maximum out-of-pocket cap is $8,150, meaning that if your care is deemed medically necessary, your out-of-pocket costs should not exceed that amount. Some plans have offered to cover patient-cost sharing for out-of-network care for COVID-19 in the absence of in-network availability. As an emergency course of action, several health plans have waived out-of-pocket costs like copays and coinsurance associated with treatment for COVID-19. To see where your health plan stands, click here.

Medicare and Medicaid: Medicare Part A (hospital stays) and Part B (doctor’s visits) will continue to charge copays and deductibles. The deductible for a 60-day hospital stay under Part A is $1,408. For Part B, the annual deductible is approximately $200. Cost-sharing related to Medicare Advantage and Medicaid plans will depend on your individual plan.

Uninsured: The Trump Administration has announced that part of the $100 billion of the $2 trillion appropriated for COVID-19-related relief in the CARES Act will be dedicated to reimbursing providers who treat uninsured patients. Provisions within the law include treatment for primary diagnosis of COVID-19 in a variety of settings, both emergency and non-emergency transportation, and post-acute care. Services that will be excluded from coverage include hospice and outpatient prescription drugs.

While further guidance is pending, Health and Human Services Secretary Alex Azar has clarified the following: “as a condition of receiving funds under this program, providers will be forbidden from balance billing the uninsured for the cost of their care.” This caveat reinforces that providers would get reimbursed at Medicare rates for delivery of uncompensated care and cannot balance bill the difference between Medicare reimbursement and the hospital’s charges.

In addition to the above, the law prohibits hospitals from charging patients beyond what they would pay in-network or what Medicare pays. The mandate against surprise billing serves to protect patients covered by government programs, employer-based plans, and self-purchased insurance.

Also, the growing loss of employer-based health coverage has prompted several states to extend their special enrollment periods to accommodate newly unemployed/uninsured patients during the pandemic. To see if you qualify for a special enrollment period, click here.

Non-ACA-Compliant Plans: Off-marketplace plans are not regulated by the ACA, and this could affect coverage for COVID-19-related treatment, where there is a possibility that treatment may not be covered outright. Examples of non-ACA plans include short-term health, fixed indemnity, and critical illness plans. These plans do not qualify for minimum essential coverage and are insufficient on their own, in our view.

Understanding insurance benefits can be daunting under ideal circumstances, let alone during a global health crisis. Consumers need enhanced accessibility and coverage now more than ever and NCL commends health plans for acting promptly to waive various cost-sharing measures. NCL urges Congress to continue to fortify and provide clear guidance for consumer protections, to ensure that they are not left stranded without vital care. Consumers, please know that there are COVID-19-related resources available to you—for more information, click here.

[1] To find a drive-thru testing site near you, click here.

NCL urges Administration to take action to combat COVID-themed fraud, patient harms online

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April 10, 2020

Contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832

Washington, DC – April 10, 2020 – The National Consumers League (NCL), in partnership with 42 patient and provider advocacy, public health, industry, and research groups, has issued joint letters to Vice President Mike Pence, the U.S. Department of Justice (DOJ), U.S. Federal Trade Commission (FTC), U.S. Food and Drug Administration (FDA), and other state and federal leaders calling for swift action to protect consumers against COVID-19 misinformation, scams, and fraud online.

“NCL commends the White House Coronavirus Task Force and other officials for their dedication in responding to the coronavirus crisis,” said NCL Executive Director Sally Greenberg. “The COVID-19 pandemic makes your work against healthcare and financial fraud more important now than ever. However to further flatten the curve and save lives, we urge the Administration to quickly implement increased evidence-based actions and to help protect consumers from predatory attempts to take advantage of our new economy.”

Since the start of the pandemic, criminals launched thousands of COVID-specific global scams and phishing attacks, using the coronavirus crisis to profit at patients’ expense. “Criminals have exploited the fear and confusion caused by the coronavirus for their own personal profits. More must be done to mitigate the health and financial harms experienced by consumers nationwide,” said Greenberg. In the past few weeks alone, more than 100,000 website domain names have been registered containing terms like “covid,” and “corona,” most of which have been found to be outright dangerous. The Federal Trade Commission indicated receipt of nearly 14,000 coronavirus-related complaints totaling fraudulent losses nearly $10 million.

NCL has long called for increased regulation and enforcement against illegal online acts that result in public health and economic harm. The joint letter encourages the Administration to move swiftly to enact and enforce existing no-cost solutions to better protect consumers. Additionally, it calls on the Administration to  ground their efforts in science, address systemic internet policy problems and prepare for an ongoing wave of COVID-19 related scams during the economic downturn.

Co-signers of the letters include Alliance for Safe Online Pharmacies, BIO, Coalition for a Safe and Transparent Internet, Consumer Brands Association, Kroll, Lilly, LegitScript, and USP. The full letter can be read here.

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About the National Consumers League

The National Consumers League, founded in 1899, is America’s pioneering consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Kudos to merchants fighting price gouging

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By Sally Greenberg, NCL Executive Director

There I was, searching for hand sanitizer to help keep reducing my risk of infection. I had scoured my local stores for hand sanitizer, to no avail. At last, desperate, I found a tiny bottle of sanitizer on the shelf at my local gas station. A bottle that usually retails for around a dollar was marked up to $3.99. What choice did I have? I paid the money and walked out of the store.

Like moths to the flame, profiteers cannot resist the allure of easy money. In this time of national emergency, it should perhaps come as little surprise that those who wish to make a quick buck off the desperation of consumers are finding few obstacles in their way.

In past natural and man-made disasters, whether in the aftermath of Hurricane Katrina or the 2008-09 financial crisis, there were always crooks who sought to deprive those in need of their last penny. Unfortunately, the COVID-19 crisis seems to be little different in this respect.

Price gouging is perhaps the most immediate threat. Most of us are aware of being asked to pay $5.00 for a bottled water in an airport or amusement park. In a time of crisis, however, the consequences of hiking prices outrageously is more than just a matter of a parched throat. For consumers in desperate need, it can come down to a choice between avoiding infection or paying the rent.

At a time when health care workers and first responders are putting their lives on the line to care for coronavirus patients, it is outrageous to see stories of unscrupulous sellers marking up the price on masks, hand sanitizer, disinfectant and, yes, even toilet paper.

Price gouging in times of crisis is illegal in most states. For example, Maryland’s anti-gouging statute prohibits raising the price of many consumer goods and services that increase the seller’s profit by more than 10 percent while the COVID-19 emergency declared by Governor Larry Hogan is in effect. California has a similar statute, punishable by up to a year in jail and a $10,000 fine. Price gouging is also illegal where I live, in the District of Columbia.

While state laws are important, enforcement alone won’t solve this problem. Reputable businesses must also play their part to keep price gouging off their shelves. This is one reason I was especially encouraged to see that that the biggest seller of consumer items on the planet, Amazon.com, stepped out so decisively against price gouging.

Last month, the company issued a policy that clearly states: “Amazon has zero tolerance for price gouging and longstanding policies to prevent this harmful practice.” In practice, this means the company is working overtime to remove price gougers from its marketplace, forwarding reports of price gouging to law enforcement, and making it clear to their sellers that price gouging is not allowed.

Amazon has removed more than half a million products and suspended more than 3,900 seller accounts in the United States.

The overwhelming majority of sellers on sites like Amazon, eBay, and other online marketplaces are honest. But these e-commerce marketplaces are where millions of consumers are going to find much-needed products. Particularly for consumers who are at high risk, these online services can be a lifeline, enabling them to stay home, avoid going out into public, and decreasing their chances of contracting the virus.

We should be very happy that there are state laws prohibiting price gouging and very grateful that Amazon has taken such a strong stance in protecting consumers by monitoring and prohibiting its sellers from gouging consumers and others during this terrible pandemic.

Watchdog org predicting ‘tsunami’ of coronavirus-related scams to come

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April 1, 2020

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832

Washington, DC–The National Consumers League (NCL) is warning consumers about an expected rise in attempts at fraud as the economy continues to tank and criminals pivot their pitches to take advantage of fearful consumers.

“When news captures the public’s attention – think major hurricanes, terrorist attacks, and economic slowdowns – scammers come out of the woodwork to take advantage of legitimate fears and concerns,” said NCL Executive Director Sally Greenberg. “With coronavirus dominating the news globally, there is an unprecedented opportunity for criminals to use the public’s fears about the virus and the resulting economic downturn to defraud consumers.”

NCL is working to educate consumers about two of the most pernicious types scams that are increasing due to coronavirus: robocalls and stimulus check scams.

Coronavirus-related robocalls

Robocalls are, at the very least, a major annoyance for most consumers. However, as the coronavirus has upended daily life, robocall operators have quickly shifted to blasting out spam phone calls offering all manner of coronavirus-related products and services. YouMail, a cloud-based telecommunications provider that tracks robocall volumes, estimates that at least one million robocalls per day are inundating Americans’ cell phones. Fraudulent robocallers are offering air duct sanitation services, work-from-home opportunities, cut-rate health insurance, and immune-system boosting nutritional supplements. Other robocalls have reportedly offered free insulin kits to diabetics, along with free coronavirus testing kits.

“At best, consumers who respond to these calls are setting themselves up to lose money for a non-existent product or service,” said John Breyault, director of NCL’s Fraud.org campaign. “At worst, delaying needed emergency treatments on the belief that a fake coronavirus treatment will save your life could be deadly to you and those you come into contact with.”

NCL’s advice to consumers is simple:

  1. If you receive a call from a number you don’t recognize, the safest course of action is simply to ignore the call.
  2. If you answer a call and suspect it’s a robocall, simply hang up. Don’t press any of the numbers the message tells you to.
  3. Never give any personal information, such as financial account number, Social Security number, full name, or mailing address to someone who contacts you via an unsolicited phone call or text message.
  4. Do not click on any links sent to you via text message from someone you don’t know. They could lead you to malware or phishing websites.
  5. If you’re being inundated by robocalls, your cellular provider may offer services that will increase the likelihood that the calls will be blocked.

Stimulus check scams

Last week, President Trump signed the biggest stimulus bill in U.S. history into law. Most American adults will receive a stimulus of $1,200 or more in the coming weeks thanks to the legislation. Crooks are already using these promised payments as a way to defraud consumers. Scams that have been reported involve crooks promising to expedite payment in exchange for a fee, impersonating a government official, and requesting sensitive personal information in order to process a check. Inaccurate social media posts have also circulated suggesting that consumers need to fill out the 2020 Census before they can receive a stimulus check.

“Stimulus checks will help millions of American households weather the coming economic downturn,” said Breyault. “Unfortunately, the phrase ‘free money from the government’ is magic to scammers’ ears. Consumers should be on the lookout for fraudsters who will try to use the coming stimulus checks to steal their money.”

Consumers can protect themselves from these scams by learning to spot these red flags:

  • The stimulus checks will be deposited automatically by direct deposit into consumers’ bank accounts for the vast majority of citizens who filed their taxes last year. Consumers without a bank account on record with the IRS will receive a paper check, but it may take several weeks longer to arrive than those who have bank accounts.
  • Anyone who emails, texts, messages, or calls you claiming to be able to expedite your stimulus check is a scammer.
  • Anyone who contacts you requesting sensitive information like PayPal account details, bank account information, or credit card numbers is trying to scam you.
  • Your answers to the Census, and whether you’ve completed it, have no impact on your eligibility for a stimulus check.

NCL asks consumers to share their stories by filing a complaint at Fraud.org via its secure online complaint form. Complaints are shared with NCL’s network of nearly 200 law enforcement and consumer protection agency partners who can and do put fraudsters behind bars.

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About the National Consumers League

The National Consumers League, founded in 1899, is America’s pioneering consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Special message from NCL’s Fraud.org about coronavirus scams – National Consumers League

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Special COVID-19 warnings: Scammers are pouncing on the opportunities presented by fear and uncertainty in our new environment. Don’t be a victim!

Fraud.orgIt’s a stressful time for consumers across the United States, with businesses closed, schools shut down, and more than a hundred million citizens under shelter-in-place orders. Unfortunately, scammers see this emergency as an opportunity to defraud consumers of hard-earned money we will all desperately need in the weeks and months ahead.

We’ve seen disturbing reports of all kinds of scams linked to the coronavirus epidemic, from sham “cures” being hawked on fly-by-night websites to phishing schemes seeking consumers’ mouseclicks with scary messages about economic collapse, and “pump and dump” schemes to get consumers to invest in coronavirus-related stocks.

With the end of the national emergency nowhere in sight, the situation with coronavirus scams is likely to get much worse before it gets better. Here at Fraud.org, we have many years of experience witnessing how scammers prey on citizens in times of disaster and distress, and we foresee challenging months ahead for consumers. But we are on your side, and we’ll be doing our best to bring you information you can use to spot and avoid these scams, as well as resources you can use to help protect your friends and family. For right now, here are some basic tips you can use to reduce your risk of becoming a victim:

  • Trust the experts. If a message you’re seeing is at odds with information being put out by trusted sources like the Centers for Disease Control, Federal Trade Commission, Food and Drug Administration, or your local health officials, there’s a high likelihood it’s a scam.
  • Check out this message from the FDA about Fraudulent Coronavirus Tests, Vaccines and Treatments.
  • You are likely to see messages urging you to act quickly, whether to buy a coronavirus “treatment” or send money for a can’t-miss investment. Remember that fraudsters try to get you to act before you think. Take your time.
  • In a time of social distancing, scammers will likely try to prey on consumers’ isolation to ensnare them in schemes like romance scams, lottery scams, or other scams where the criminals earn their targets’ trust over time.
  • Remember that scammers follow the headlines just like the rest of us. In particular, we expect scams promising COVID-19 stimulus checks to get more prevalent as the government’s coronavirus relief efforts ramp up.
  • The Federal Trade Commission has a wealth of information about coronavirus-related scams. Visit ftc.gov/coronavirus for up-to-date information.

NCL praises AG Barr for crackdown on COVID-19 scammers

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March 25, 2020

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832

Washington, DC–The National Consumers League (NCL) is applauding efforts by the Department of Justice and U.S. Attorney General William Barr to crack down on a wave of scammers and hackers trying to capitalize on the COVID-19 outbreak by ordering U.S. attorneys offices across the country to investigate and prosecute “all criminal conduct related to the current pandemic.” NCL greatly supports the move to make this a priority.

NCL operates a fraud prevention and education program, Fraud.org, working with law enforcement agencies in the U.S. and Canada to track trends in fraudulent activity. NCL also runs the Alliance Against Fraud, a coalition of nonprofits, government, and businesses dedicated to fraud awareness, prevention, and supporting criminal prosecution of fraudulent business practices. The League also works to advocate for science- and evidence-based claims about healthcare, foods, and dietary supplements.

As Barr noted earlier this week, “[i]n particular, there have been reports of individuals and businesses selling fake cures for COVID-19 online and engaging in other forms of fraud, reports of phishing emails from entities posing as the World Health Organization or the Centers for Disease Control and Prevention.”

“AG Barr is right; we’re seeing an upsurge in phishing emails purporting to be from public health organizations offering information on the coronavirus outbreak,” said NCL Executive Director Sally Greenberg. “During this time of vulnerability and uncertainty, consumers shouldn’t be left to fend for themselves in determining whether the claims they are seeing are true. We are pleased that the Trump Administration is taking the risks of scammers capitalizing on this global crisis seriously.”

In his letter, the Attorney General also pointed to recent reports about “malware being inserted onto mobile apps designed to track the spread of the virus.” Last week, an Android app called “COVID-19 Tracker App” surfaced. It’s actually a piece of ransomware designed to lock down access to a consumer’s phone.

“NCL continues to work to fight fraud, protect consumers, and collaborate with law enforcement to track and prosecute those who prey upon our citizens,” said NCL Vice President of Public Policy, Telecommunications and Fraud John Breyault. “Now more than ever, consumers need allies and watchdogs on their side to help protect them from predatory opportunists.”

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About the National Consumers League

The National Consumers League, founded in 1899, is America’s pioneering consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.