More Americans are being tested for coronavirus than ever before – and that could mean more surprise medical bills.
Congress wrote rules in March aimed at making coronavirus testing free for all Americans. Patients with or without insurance have found loopholes in these new coverage programs. They have bills ranging from a few dollars to over $ 1,000.
I’ve spent a lot of time in the past four months collecting patient bills related to coronavirus. As part of this project, I read more than 100 patient reports on coronavirus testing. Many patients like not to report any fees at all, while others have been billed high unexpected fees or have claims related to coronavirus testing rejected.
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The surprise bills hit both uninsured Americans and those with robust coverage. Health data company Castlight estimates that 2.4 percent of coronavirus test bills leave some of the fee to consumers, meaning millions of patients may have to pay 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 website
Many states, counties, and cities now have public testing facilities. Very few patients have reported surprising medical bills from these testing sites (although this is not impossible). You can usually use your state department of health website to find public testing options.
If a public testing site isn’t an option for where you live, you can consider your GP or a state-qualified health clinic. The largest coronavirus testing surprise bills that I review are typically from patients tested in hospitals and freestanding emergency rooms. These places often charge patients what is known as a facility fee, which is the fee to enter the room and find service.
Patients find that these fees may apply even if they do not enter the facility. Several patients in a Texas emergency room were charged a set-up fee of $ 1,684 for their drive-through coronavirus tests. A patient in New York had to pay a fee of $ 1,394 to test in a tent outside a hospital. The bulk of the bill was the setup fee. Investigative news site ProPublica has reported that setup fees can sometimes cost 10 times the coronavirus test itself.
If you get your test from a family doctor or at a public test 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.
Ask your provider what they will charge you
When patients receive a surprising medical bill related to a coronavirus test, the fees they often face are not for the test itself. Instead, they are intended for other services that the patient may not have known about.
Some of these services are useful. Many coronavirus test bills have fees for associated doctor visits. Others make less sense, such as those looking for sexually transmitted diseases that have nothing to do with coronavirus. 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 appear at public testing sites: a Connecticut doctor regularly tested patients for dozens of diseases while driving through town. Patients thought they were just getting coronavirus tests.
To avoid these additional costs, ask your provider what diseases they are screening for. It can be as simple as saying, “I understand I have a coronavirus test. Are there any other services you would charge me for? “Understanding this better can save you headaches later and help you make an informed decision about what care is actually needed. If your providers can’t tell you what they’re charging, this may be a signal to send you elsewhere want to search.
Uninsured? Ask your doctor to bill the government, not you
Uninsured patients faced coronavirus bills in excess of $ 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 a provider aid fund: health care providers can apply for reimbursement for coronavirus tests and treatments offered to people without insurance cover. Again, it pays to ask in advance how providers will handle uninsured patients and whether they will submit 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 the cost of coronavirus testing for uninsured Americans. This means your state government can pay the bill instead of you. Here you can find out if you live in one of these states.
The coronavirus outbreak>
Things to know about testing
Confused by Coronavirus Testing Conditions? Let us help:
antibody: A protein produced by the immune system that can recognize and attach to certain types of viruses, bacteria or other invaders.Antibody test / serology test: A test that detects antibodies specific to the coronavirus. About a week after the coronavirus infects the body, antibodies start appearing in the blood. Because antibodies take so long to develop, an antibody test cannot reliably diagnose an ongoing infection. However, it can identify people who have been exposed to the coronavirus in the past.Antigen test: This test detects parts of coronavirus proteins called antigens. Antigen tests are quick and only take five minutes. However, they are less accurate than tests that detect genetic material from the virus.Coronavirus: Any virus that belongs to the Orthocoronavirinae virus family. The coronavirus that causes Covid-19 is known as SARS-CoV-2. Covid19: The disease caused by the new coronavirus. The name stands for Coronavirus Disease 2019.Isolation and quarantine: Isolation is separating people who know they have a contagious disease from those who are not sick. Quarantine refers to restricting the movement of people who have been exposed to a virus.Nasopharyngeal smear: A long, flexible stick with a soft swab that is inserted deep into the nose to collect samples from the space where the nasal cavity meets the throat. Samples for coronavirus tests can also be taken with swabs that don’t go as deep into the nose – sometimes called nasal swabs – or with mouth or throat swabs.Polymerase chain reaction (PCR): Scientists use PCR to make millions of copies of genetic material in a sample. With the help of PCR tests, researchers can detect the coronavirus even when it is scarce.Viral load: The amount of virus in a person’s body. In people infected with the coronavirus, viral loads can peak before symptoms, if any.
To contest a surprise bill, know your federal law rights
New federal laws regulate how healthcare providers and insurers can bill patients for coronavirus tests. Knowing how they work can help you push back fees that may not be allowed.
The new laws require health insurers to cover coronavirus tests at no cost to patients. This means that standard deductibles and co-payments for other services do not apply.
These laws also mandate that insurers must cover all other benefits required for the coronavirus test, but don’t define what does the cut. Most experts agree that a doctor visit fee is a fairly clear example of a service that should be qualified and that patients faced with such bills should seek coverage from their insurer. Other services, like a flu test or even an X-ray taken alongside a coronavirus test, create a bleak situation. When faced with such charges, you should consult your doctor to let the insurer know why the additional care is required was.
One last thing you should know about federal laws is that insurers must 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 of the network, a situation I have seen many times. The typical rules of your health plan for off-network care 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’s safer to stick with providers on the network whenever possible.
Received an unexpected invoice? Medical codes could be the culprit
Another issue is what billing codes your doctor used for the test visit. Many of the surprise bills I review have a doctor charge a visit fee and send the test to an outside lab that makes its own claim. The health plan may provide for 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 healthcare provider to have your visit re-encoded and a coronavirus test displayed.
Tell us what happened to you. It helps our journalism.
Almost everything I know about coronavirus testing billing comes from reading the bills that hundreds of Times readers have sent describing their experience. If you receive an invoice for coronavirus tests and treatments, 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 face unusually high fees.