April 20, 2020

Paying for COVID-19 | Webinar with Dr. Amy Mechley

Dean Graham

Dr. Amy Mechley, founder of Integrated Family Care (a DPC out of Cincinnati) talks about the testing and treatment for COVID-19, and what self-funded plan sponsors should be aware of to mitigate their claims risk.

Q: There’s a lot of information flying around out there. Explain to us briefly the 2 types of tests for COVID-19, and their relative costs to a health plan. (Dr. Amy Mechley)  

  • nasopharyngeal for very sick people in ER 
  • IgM/IgG blood test that must be administered by trained professional 
  • $51 for nasal test which must be covered by the insurance plan
  • $50-$250 for the blood test, which is very expensive for the type of test it is
  • Treatment for COVID-19 is really only for very sick (acute) patients. 85-90% of people are sent home and take OTC medications. Therefore, a positive diagnosis may not necessarily change the course of treatment.
  • Getting tested just because you want to know will cost the patient money, the plan money, but make little other difference. Assume you're sick and follow guidelines unless you feel acute symptoms.
  • When people start going back to work, employers will need to discuss their plan for covering testing en masse

Q: What does it look like if someone receives a positive diagnosis, for the patient and for the plan sponsor who will see the bills come in? (Dr. Amy Mechley) 

  • 85-90% of people are sent home and take OTC medications
  • Could still receive bills for going into the ER...
  • Treatment reserved for severe and critical patients
  • Daily hospital costs can be between $3,000 - $5,000 for asymptomatic to moderate cases (estimated by Society of Actuaries whitepaper) 
  • ICU/Ventilator costs can be $10,000 - $20,000(estimated by Society of Actuaries)

Q: How is COVID different from MRSA/SARS in the past? Why are we responding so aggressively this time around? (Dr. Amy Mechley) 

  • SARS is a syndrome brought on by a few different viruses. We are not seeing SARS-like symptoms in these patients. But COVID has a very wide range of symptoms that makes it really hard to track down. 
  • The infection rate of COVID is very very high, hence the rapid spread and need for social distancing. We don’t know yet how long people will have antibodies, if this will resurge, anything like that.

Q: So aside from the costs themselves, how will this affect stop-loss expectations as a self-funded plan sponsor? (Kevin Schlotman)

  • Stop-loss vendors are concerned about the aggregate (lots of small dollar claims for tests and such) rather than 1 big claim
  • Larger bills (above $150K?) might have some exposure of increase at renewal, but it's not a break the bank scenario
  • The numbers right now don’t point to seeing huge stop-loss rate increases unless you’re on a level funded plan

Q: What about non-COVID medical care? A lot of elective surgeries & visits are delayed: how should plan sponsors be preparing for this influx of new bills & claims? (Kevin Schlotman)

  • Right now you should be banking money as a self-funded plan sponsor. Your Per Month is going to be way lower than you’d expect, but it will come back up
  • Elective surgeries will start back up with Phase 1 state back-to-work programs

Q: Let’s talk about fraud: what should plan sponsors should be looking out for, and telling their employees to look out for. (Dr. Amy Mechley & Kevin Schlotman)

  • Blood tests are not FDA approved and are not OK to do at home- the results will vary widely. Only sick people should get tested and only by a trained nurse professional. 
  • Fake bills could start coming in to your insurance company to be paid.
  • Claims examiners don’t know what their patients are doing. We must rely on the patients/employees to tell us if they get EOBs for visits they didn’t make
  • Encourage employees to be extra scrupulous about reading their bills and EOBs

Q: What advice would you give anyone accessing the medical system at this time? (Dr. Amy Mechley) 

  • Use telemedicine or phone call consultations - covered by most plans now
  • Avoid going to a hospital - that’s just unnecessary risk of getting infected
  • This points to the whole reason not to have elective surgery in a hospital in the first place: b/c there’s so many sick people
  • Diagnosis won’t change the course of your treatment so don’t get it
Dr. Amy Mechley, MD, is the co-founder of Integrated Family Care, a Direct Primary Care provider based in Cincinnati. She also serves as Adjunct Professor at University of Cincinnati College of Medicine, specializing in family medicine. She has worked for over 20 years as a clinical consultant, taking an intensive look at healthcare spend and healthcare reform (both for CMS & Commercial insurance).


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