COVID-19 Effects on TPAs

Surprise Billing Ban May be Included in Latest Coronavirus Legislation

As the government races to push out relief for Americans, and businesses, the newest stimulus package, may include a ban on surprise billing for those affected with COVID-19. For providers and hospitals who receive assistance from the government, lawmakers are considering a ban on billing patients for any part of COVID-19 treatment that is denied by insurance. Read more about surprise billing for coronavirus.


COVID-19 May Have This Shocking Effect on 2021 Health Insurance Premiums

The company ehealth conducted a study and invited the leading insurance companies they have a relationship with to respond. In a surprising turn, 83 percent of insurance companies surveyed said they do not anticipate the coronavirus outbreak to cause an increase in premiums in 2021. In fact, 97 percent said they are waiving the cost of testing for coronavirus and 60% are allowing their members affected by COVID-19 to defer premiums. For more statistics about this survey read here.


ADA Asks TPAs to Adjust Billing Codes and Practices

The American Dental Association (ADA) has written a letter to third-party payers asking for third-party administrators of dental plans to consider changes in coding and billing due to COVID-19. The ADA highlighted several areas they would like administrators to consider. These include:

  • The ADA asks that temporary procedures not be bundled in with permanent fixes
  • Payment for out-of-network costs if an in-network provider could not be located because of office closings.
  • Urge payers to consider covering telecommunication technology on a continuing basis.
  • Remove limitations for periodontal maintenance, topical fluoride and sealant applications since patients may not have had access to these during the outbreak.
  • The cost of infection prevention and control have increased during COVID-19 and appropriate protective personal equipment and other procedures will increase. The ADA asks that these be considered when reviewing fee schedules for their contracted providers.

Read more about the ADA’s requests here.

Source: American Dental Association

ERISA Lawsuits Still Press Forward Despite COVID-19

Despite the fact the United States is in lockdown for social distancing, ERISA (Employee Retirement Income Security Act) lawsuits are still continuing to move forward. According to, it’s important for plan sponsors to pay attention to what is continuing to happen, as judges are still ruling on motions and conducting business through ECF—an electronic filing system. It’s unclear yet if a plan fiduciary could be accused of failing in its ERISA duties during the pandemic. However, these kinds of lawsuits should be considered when managing a retirement plan. Overall, it’s important to remember to monitor ERISA cases to avoid surprises after the COVID-19 crises is past us. Read more about ERISA planning here.


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