Will You Have to Pay for a Coronavirus Test? Here’s How to Avoid a Surprise Bill

This is an updated version of an article that was first published on November 13, 2020.

The wave of coronavirus infections driven by the Delta variant is leading to a new surge in testing – and that could mean more surprising medical bills.

Congress wrote rules last spring to make most coronavirus tests free for all Americans. But patients, with or without insurance, have found loopholes in these new insurance programs.

Federal law, for example, does not require insurers to undertake the routine exams that a growing number of workplaces and schools mandate. Some doctors and hospitals have pinned unexpected fees on coronavirus testing bills, causing patients to pay surprising fees ranging from a few dollars to over $ 1,000.

For the past year I have been collecting bills from patients related to the coronavirus. As part of this project, I read more than 100 patient stories about coronavirus testing. Many patients are happy to not report a fee at all, while others have been charged high unexpected fees or have claims related to coronavirus testing declined.

[Have a bill you want to share? Submit it here.]

The surprising bills have hit both uninsured Americans and those with robust coverage. Health data firm Castlight estimates that 2.4 percent of coronavirus test bills leave some of the fee to consumers, meaning millions of patients could face unexpected fees.

These are some simple steps you can take to reduce your chances of becoming one of them.

Many states, counties, and cities / towns now have public testing facilities. Very few patients have reported surprising medical bills from these testing sites (although this is not impossible). Typically, you can use your state’s Department of Health website to find public testing options.

If a public test site in your place of residence is out of the question, you can consider your family doctor or a state-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. These places often charge patients what is known as a facility fee, which is the fee for entering the room and receiving service.

Patients find that these fees can show up even if they don’t actually enter the facility. Several patients in a Texas emergency room had setup fees of $ 1,684 added to their drive-through coronavirus tests. A patient in New York had to pay a fee of $ 1,394 to test in a tent outside of a hospital. The bulk of the bill was the setup fee. Investigative news site ProPublica has reported that facility fees can sometimes be ten times the coronavirus test itself.

If you have your test carried out by a family doctor or at a public testing site, you shouldn’t have to worry about this type of billing. They typically don’t charge setup fees for coronavirus testing or other types of care.

When patients receive a surprise medical bill related to a coronavirus test, they are often not charged for the test itself, but for other services that the patient may not have known about.

Some of these make sense: Many coronavirus test bills include fees for the associated doctor visit. Others make less sense, like the bills that include sexually transmitted disease screenings. These additional fees seem to be a bit more common in emergency rooms or when healthcare providers send their samples to outside laboratories. But they can also happen at public test sites: a Connecticut doctor regularly tested patients for dozens of diseases while driving through town. Patients thought they would just get coronavirus tests.

To avoid these additional costs, ask your doctor what diseases they are being screened for. It can be as simple as saying, “I understood that I have a coronavirus test. Are there any other services you will bill me for? ”Understanding this in advance can save you headaches later and make an informed decision about what care is actually needed. If your vendors can’t tell you what they’re charging, it may be a sign that you want to go elsewhere for help.

Uninsured patients faced coronavirus bills greater than $ 1,000, according to billing documents verified by the New York Times.

This type of billing is legal: healthcare providers are not required to offer free coronavirus tests to Americans without health insurance. However, you do not necessarily have to bill the patient directly. The federal government has set up an aid fund: healthcare providers can apply for reimbursement for coronavirus tests and treatments that are not insured. Here, too, it is worthwhile to find out in advance how the providers deal with uninsured patients and whether they are committed to the fund. Unfortunately, they are not obliged to do so – and could pursue the debt further.

You should also be aware that 17 states have approved their state Medicaid plans to cover coronavirus testing costs for uninsured Americans. That means your state government can pay the bill instead of you. You can find out here whether you live in one of these federal states.

New federal laws regulate how healthcare providers and insurers can bill patients for coronavirus tests. Knowing how they work can potentially help drive back illegal fees.

The new law stipulates that the health insurance companies must take over coronavirus tests prescribed by a doctor at no cost to the patients. This means that the usual deductibles and co-payments that you would expect for other services do not apply.

There is one important exception to these 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 is up to your health plan to decide whether or not to want to pay those bills.

With this type of testing, you should be extra careful where you will be tested and ask more questions about the fees you may have to pay. Some employers are already instructing their workers to be tested in public locations, in part to reduce the possibility of surprise charges.

There is still a small gray area with the coronavirus tests that insurers have to take over. The law requires insurers to provide all other services required for the coronavirus test, but does not define what does the cut. Most experts agree that a doctor visit fee is a pretty clear example of a service that should qualify, and that patients faced with such bills should seek coverage from their insurer. Other services, like a flu test or even an X-ray done alongside a coronavirus test, present a darker situation. When faced with such charges, you should ask your doctor to tell the insurer why the additional treatment was needed .

One last thing you should know about federal laws is that they require insurers to fully cover coronavirus testing off the network. This can be especially important for patients who go to a doctor on the network but unknowingly have their sample sent to a laboratory outside the network, a situation I have seen many times. The typical rules of your health insurance company for off-grid supply should not apply to the coronavirus test. However, they can be applied to other parts of the testing experience (such as the doctor’s visit fee) so it is safer to stick with on-network providers whenever possible.

Another issue to look out for is what billing codes your doctor used for the test visit. Many of the surprising bills I’ve checked involve a doctor charging a visit fee and then sending the test to an outside lab that will file its own claim. The health insurance plan may charge an additional payment for the doctor’s visit, as this is not clearly linked to the coronavirus test in the billing documents. If so, you may need to work with your doctor to have your visit re-encoded to indicate that a coronavirus test was done.

Almost everything I know about coronavirus test billing comes from reading the bills hundreds of Times readers sent in describing their experience. If you receive an invoice related to coronavirus testing and treatment, please take a moment to submit it here. It will help me keep reporting the types of fees patients face and can help identify areas of the country where patients are paying abnormally high fees.

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