Unemployment, COVID-19, and Testing Claims

America’s new normal. 

Unemployed, uninsured, unbelievable! The U.S. Bureau of Labor Statistics indicates that 12.6 million Americans are on unemployment rosters around the country; 32.5 percent of the adult population has been jobless for over five months. Of those who are jobless, many remain uninsured. What happens when these individuals are infected with COVID? The answer is simple: the federal government is supposed to cover testing and treatment.

States with the highest uninsured rates are receiving the majority of dollars. How much are we talking about? How does $1.5 billion sound? That’s a pretty penny, though lower than many experts anticipated. QuoteWizard by Lending Tree evaluated data from the U.S. Centers for Disease Control and Prevention (CDC) on claims reimbursement to providers over the course of the pandemic. The study looked at the total funds provided to each state through uninsured claims for testing and treatment. That figure was then divided by the total number of COVID-19 cases for the state, as well as those who are uninsured. Keep in mind that on top of 12.6 million unemployed in the U.S., there are well over ten million cases of the virus, with over 50,000 hospitalizations at present.

States with the highest numbers of uninsured people were among those that received the most funding in COVID-19 reimbursement – in other words, the highest costs per case were associated with states with the highest levels of uninsured individuals. Ten of these states were non-Medicaid expansion states (specifically Texas, North and South Carolina, Georgia, Florida, Tennessee, Kansas, Mississippi, Alabama, and South Dakota). New Jersey sat atop the list, followed by North Carolina, Texas, and Tennessee. While the average cost per case was $142, the rate variation between New Jersey and Tennessee was fascinating:

  • New Jersey had 222,193 cases, with over $46 million for testing claims, while close to $84 million was allocated for treatment claims reimbursement at $586 per case.
  • Tennessee had over 233,000 cases, with roughly $19 million in testing claims and almost $23 million in treatment claims. The cost per case there was $180.
  • For a point of reference, Montana was ranked last: 24,093 cases, $96,000 in testing claims, and $103,000 in treatment claims. The cost per case was…wait for it…$8.

The URL for the list of all states appears on the QuoteWizard site.

I’m unsure what’s more intriguing about these numbers: the variations in treatment and costs per case, or considering how much higher these costs will get? Economic relief packages passed by Congress allocated $176 billion towards reimbursement for hospitals and healthcare facilities.

With the latest COVID wave hitting states with the highest numbers of persons impacted most by the social determinants of health (SDoH), this week’s Monitor Mondays Listeners Survey asked whether there will be sufficient reimbursement by the federal government to pay all submitted claims. The answers may surprise you, and can be viewed here.

Programming Note: Ellen Fink-Samnick is a permanent panelist on Monitor Mondays. Listen to her live reporting every Monday at 10 a.m. EST.

Facebook
Twitter
LinkedIn

Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management and Social Determinants of Health: Case Management’s Next Frontier (with foreword by Dr. Ronald Hirsch), are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk Ten Tuesdays, and member of the RACmonitor Editorial Board.

Related Stories

Coding the Deadly COVID

Coding the Deadly COVID

While it is not in the news on a daily basis any longer, COVID has not gone away. Since the start of the pandemic, we

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

I050825

Mastering ICD-10-CM Coding for Diabetes and it’s Complications: Avoiding Denials & Ensuring Compliance

Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!

May 8, 2025

Trending News

Featured Webcasts

Navigating the 3-Day & 1-Day Payment Window: Compliance, Billing, and Revenue Protection

Navigating the 3-Day & 1-Day Payment Window: Compliance, Billing, and Revenue Protection

Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.

May 15, 2025
Audit-Proof Your Wound Care Procedures: Expert Insights on Compliance and Risk Mitigation

Audit-Proof Your Wound Care Procedures: Expert Insights on Compliance and Risk Mitigation

Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.

April 17, 2025
Utilization Review Essentials: What Every Professional Needs to Know About Medicare

Utilization Review Essentials: What Every Professional Needs to Know About Medicare

Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.

March 20, 2025

Rethinking Observation Metrics: Standardizing Data for Better Outcomes

Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.

February 25, 2025

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24