Rep. Pallone: E&C Launches Investigation Into Health and Dental Insurers
The Committee's investigation follows concerning reports that some health plans may not be complying with consumer protections in both the Families First Coronavirus Response Act (the Families First Act) and the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act), and that consumers are therefore experiencing increased barriers to free COVID-19 testing. The investigation also follows reports that the health insurance industry is reporting massive profits during the pandemic, as patients defer non-essential medical care.
"These developments raise important questions about the extent to which the insurance industry may be profiting off the pandemic while simultaneously taking action to reduce access to free COVID-19 testing," the Committee leaders wrote in their letters to health insurance companies. "We write to request information about your company's coverage policies and practices for COVID-19 tests and related items and services. Additionally, we are requesting information on whether these increased profits are being used to provide consumers relief, such as through premium reductions, rebates, zero cost-sharing for COVID-19 treatments, or other financial assistance."
"Now, at the same time that some insurance companies have reportedly failed to provide COVID-19 testing coverage free of cost-sharing, the health insurance industry appears to be having a banner year," the Committee leaders wrote to health insurers. "In some cases, insurers have doubled their quarterly profits as compared to last year. It appears these increased profits are largely the result of insurers spending less on consumers' medical benefits during the COVID-19 pandemic."
Many elective surgeries have been canceled or postponed due to the pandemic, saving insurers potentially billions of dollars in forgone medical claims. Many insurers are also reportedly spending significantly less on their customers' routine or preventive health care benefits, including dental benefits, as compared to the prior year. The Committee leaders pointed to protections in the Affordable Care Act (ACA) that cap health insurance companies' profit margins and require them in certain instances to issue rebates to consumers on premiums paid.
"In a time of national crisis and when many families are struggling financially, the insurance industry must do its part to assist individuals who are deferring medical procedures, avoiding doctors' offices, or otherwise not using the health insurance for which they are paying," the Committee leaders continued in their letter to health insurers. "This includes issuing consumer rebates as required under the ACA, but also providing immediate relief to consumers, such as through premium credits and rebates, coverage of COVID-19 treatments without cost-sharing, and rigorous adherence to all COVID-19 testing coverage requirements mandated by law."
In a separate series of letters, the Committee leaders raised questions about whether the dental insurance industry may also be profiting off the pandemic and inquired into whether the dental insurers are offering consumers or providers financial assistance during these challenging times.
As part of their inquiry, the Committee leaders requested documents and answers to a series of questions from the health and dental insurance companies by
- The net income and/or earnings for years 2018, 2019, and Quarter 1 and Quarter 2 of 2020.
- The total amount of member premiums collected and claims paid out for years 2018, 2019, and Quarter 1 and Quarter 2 of 2020.
- Information on whether the insurers are providing financial assistance to enrollees or employers during the COVID-19 pandemic, including through premium credits, grace periods, or rebates for enrollees.
- Information on whether the insurers are providing financial assistance to providers during the COVID-19 pandemic, including through increased provider reimbursement, or low or zero cost loans.
- A complete description of the health insurance companies' COVID-19 testing coverage policies and practices.
- Copies and records of all complaints from consumers billed for diagnostic or serological tests for COVID-19 and related items and services.
The letters sent to each of the health insurance companies are available below:
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The letters sent to each of the dental insurance companies are available below:
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- United Concordia Dental (https://energycommerce.house.gov/sites/democrats.energycommerce.house.gov/files/documents/UnitedConcordia.2020.8.13.Letter%20re%20Insurers%20COVID19%20Profits%20and%20Testing.OI_.HE_.pdf)
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