This is an updated version of an article first published on November 13, 2020.
The Delta variant-driven wave of coronavirus infections sparks another wave of testing — and that could lead to more surprising medical bills.
Congress last spring wrote rules to make most coronavirus tests free to all Americans. But patients, with or without insurance, have found gaps in those new coverage programs.
Federal law, for example, doesn’t require insurers to cover the routine tests that a growing number of workplaces and schools require. Some doctors and hospitals have tacked unexpected charges on coronavirus testing bills, inflicting surprise costs on patients ranging from a few dollars to more than $1,000.
For the past year, I have collected patient bills related to the coronavirus. As part of that project, I read over 100 patient stories about coronavirus testing. Many patients are happy to report no charges at all, while others have been charged large unexpected costs or claims related to coronavirus testing have been rejected.
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The surprise bills have hit uninsured Americans as well as those with robust coverage. Health data company Castlight estimates that 2.4 percent of coronavirus test bills leave some of the cost up to consumers, meaning millions of patients could face fees they didn’t expect.
These are some simple steps you can take to reduce your chances of becoming one of them.
If you can, get tested on a public site
Many states, counties and cities now have public testing facilities. Very few patients have reported surprising medical bills from those testing sites (though it’s not impossible). You can usually use your health department’s website to find public testing options.
If a public testing site is not an option where you live, consider your primary care physician or a federally qualified health clinic. The biggest surprise coronavirus test bills I’ve reviewed tend to come from patients being tested in hospitals and freestanding emergency rooms. Those places often charge patients for something called a facility fee, which is the cost of entering the room and seeking service.
Patients find that these fees can crop up even when they don’t actually set foot in the facility. Multiple patients at a Texas emergency room had $1,684 facility fees tacked onto their drive-through coronavirus tests. A patient in New York had to pay $1,394 for her test in a tent outside a hospital. The bulk of the bill was the facility fee. The research news site ProPublica has reported how facility fees can sometimes cost as much as 10 times the coronavirus test itself.
If you get your test at a primary care provider or at a public testing site, you don’t have to worry about that kind of billing. They typically don’t charge a facility fee for coronavirus testing or other types of care.
Ask your provider what they charge you
When patients receive a surprise medical bill in connection with a coronavirus test, the charges they face are often not for the test itself, but for other services that the patient may not be aware of.
Some of these make sense: Many coronavirus test bills have fees for the associated doctor’s visit. Others make less sense, such as the sexually transmitted disease screening bills. Those extra costs seem to be a little more common in emergency rooms, or when health care providers send their samples to outside labs. But they can also occur at public testing sites: A Connecticut doctor regularly tested patients for dozens of diseases at a city drive-through. The patients thought they were just getting coronavirus tests.
Ask your provider what diseases they will screen for to avoid those extra costs. It can be as simple as saying, “I understand I have to undergo a coronavirus test. Are there any other services you are billing me for?” Understanding that better in advance can save you headaches later and help you make an informed decision about what care is actually needed. If your caregivers can’t tell you what they’re charging for, that could be a sign that you want to seek care elsewhere.
Uninsured? Ask Your Doctor to Bill the Government, Not You
Uninsured patients have faced coronavirus bills in excess of $1,000, according to billing documents reviewed by NewsMadura.
That kind of billing is legal: Health care providers aren’t required to provide free coronavirus testing to Americans who don’t have health insurance. But they don’t necessarily have to bill the patients directly. The federal government has set up a health care aid fund: health care providers can request reimbursement for coronavirus testing and treatment from people without coverage. Again, it pays to ask in advance how providers deal with uninsured patients and whether they submit to the fund. Unfortunately, they are not obligated to do so – and can continue to pursue the debt.
You should also be aware that 17 states have approved their state Medicaid plans to cover the cost of the coronavirus test for uninsured Americans. This means your state government can foot the bill instead of you. You can find out if you live in one of these states here.
To challenge a surprise law, you need to know your rights under federal law
New federal laws regulate how health care providers and insurers can bill patients for coronavirus testing. Understanding how they work can help you reduce costs that may not be allowed.
The new laws require health insurers to pay for coronavirus tests ordered by a doctor at no cost to patients. This means that standard deductibles and co-payments that you would encounter for other services do not apply.
There is one important exception in those laws: Insurers are not required to cover routine coronavirus tests ordered by a school or workplace. For example, if your job requires you to be tested every week, it’s up to your health plan whether it wants to pay those bills.
For that kind of testing, you need to be especially careful about where you’re being tested and ask more questions about the fees you might have to pay. Some employers are already ordering their employees to get tested in public locations, in part to reduce the chance of surprise charges.
There is still a bit of a gray area for the coronavirus tests that insurers do have to cover. The law requires insurers to cover all other services needed to get the coronavirus test, but doesn’t define what makes up the discount. Most experts agree that reimbursement for a doctor’s visit is a pretty clear example of a service that should qualify, and that patients faced with these types of bills should rely on their insurer for coverage. Other services, such as a flu test or even an X-ray performed alongside a coronavirus test, pose a murkier situation. If you are faced with such fees, you can turn to your doctor to tell the insurer why the extra care was needed.
One last thing to know about the federal laws is that they require insurers to fully cover out-of-network coronavirus testing. This can be especially important for patients who go to an in-network physician but unknowingly have their sample sent to an off-network lab, a situation I’ve seen many times. Your health insurance policy’s typical rules for out-of-network care do not apply to the coronavirus test. However, they can be applied to other parts of the testing experience (e.g. the doctor’s visit fee), so it’s safer to stick with in-network providers whenever possible.
Receive an unexpected bill? Medical codes could be the culprit
Another issue to look out for is which billing codes your doctor used for the test visit. Many of the surprise bills I’ve looked at involve a doctor charging a visitation fee and then sending the test to a third-party lab that makes its own claim. The health plan may apply a co-payment to the doctor’s visit because it is not clearly linked to the coronavirus test in the billing data. In this case, you may need to work with your health care provider to recode your visit to show that a coronavirus testing has taken place.
Tell us what happened to you. It helps our journalism.
Almost everything I know about coronavirus test billing comes from reading the bills sent by hundreds of Times readers describing their experiences. If you receive a bill related to research and treatment for the coronavirus, please take a moment to submit it here. It will help me to continue reporting on the types of fees patients face, and can help identify areas in the country where patients face unusually high fees.