Will You Have to Pay for a Coronavirus Test? Here’s How to Avoid a Surprise Bill – The New York Times

This is an updated version of an article first published on Nov. 13, 2020.

The Delta-variant-driven wave of coronavirus infections is driving a new surge in testing and that could mean more surprise medical bills.

Congress wrote rules last spring to make most coronavirus testing free for all Americans. But patients, with or without insurance, have found holes in those coverage programs.

Federal law does not, for example, require insurers to cover the routine testing that a growing number of workplaces and schools are mandating. Some doctors and hospitals have tacked unexpected fees onto coronavirus testing bills, leaving patients with surprise charges ranging from a few dollars to over $1,000.

In the past year, Ive collected patients bills related to coronavirus. As part of that project, Ive read through more than 100 patient stories about coronavirus tests. Many patients are happy to report no charge at all, while others have been billed large unexpected fees or denied claims related to coronavirus tests.

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

The surprise bills have hit uninsured Americans as well as those with robust coverage. The health data firm Castlight estimates that 2.4 percent of coronavirus test bills leave some share of the charge to consumers, which means there could be millions of patients facing fees they did not expect.

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

Many states, counties and cities/towns now have public testing facilities. Very few patients have reported surprise medical bills from those testing sites (although its not impossible). You can typically use your state health department website to find public testing options.

If a public test site isnt an option where you live, you might consider your primary care doctor or a federally qualified health clinic. The largest surprise coronavirus test bills Ive reviewed tend to come from patients who are tested in hospitals and free-standing emergency rooms. Those places often bill patients for something called a facility fee, which is the charge for stepping into the room and seeking service.

Patients are finding that these fees can pop up even when they dont actually set foot in the facility. Multiple patients at one Texas emergency room had $1,684 facility fees tacked onto their drive-through coronavirus tests. A patient in New York faced a $1,394 charge for her test at a tent outside a hospital. The majority of the bill was the facility fee. The investigative news site ProPublica has reported on 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 test site, you shouldnt have to worry about that type of billing. They typically do not charge facility fees for coronavirus tests or any other types of care.

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

Some of these make sense: Many bills for coronavirus tests have fees for the doctor visit that went along with it. Others make less sense, like the bills that include screenings for sexually transmitted diseases. Those extra fees appear to be a bit more common in emergency rooms, or when health providers send their samples to outside laboratories. But they can happen at public testing sites, too: One Connecticut doctor regularly tested patients for dozens of illnesses at a town drive-through. The patients thought they were simply getting coronavirus tests.

To avoid those extra charges, ask your provider what diseases they will screen for. It can be as simple as saying: I understand Im having a coronavirus test. Are there any other services youll bill me for? Having a better understanding of that up front can save you a headache later, and you can make an informed decision about what care is actually needed. If your providers cant tell you what theyll bill for, that may be a signal you want to seek care elsewhere.

Uninsured patients have faced coronavirus bills upward of $1,000, according to billing documents reviewed by The New York Times.

That type of billing is legal: Health care providers are not required to provide free coronavirus tests to Americans who lack health insurance. But they do not necessarily have to bill patients directly. The federal government has set up a provider relief fund: Health providers can seek reimbursement for coronavirus testing and treatment provided to those without coverage. Once again, it pays to ask ahead of time how providers handle uninsured patients and whether they submit to the fund. Unfortunately, they are not required to do so and could continue to pursue the debt.

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

New federal laws regulate how health providers and insurers can bill patients for coronavirus tests. Understanding how they work can help you push back on charges that may not be allowed.

The new laws state that health insurers must cover coronavirus tests ordered by a doctor without any cost to the patients. This means that standard deductibles and co-payments youd face for other services do not apply.

There is one important exception in those laws: Insurers do not have to cover routine coronavirus testing ordered by a school or workplace. If your job mandates that you get tested each week, for example, it is up to your health plan whether it wants to pay those bills.

For that type of testing, youll want to be especially careful about where you get tested, and ask more questions about the fees you may have to pay. Some employers are already directing their workers to be tested at public sites, in part to reduce the possibility of surprise charges.

For the coronavirus tests that insurers do have to cover, there is still a bit of a gray area. The law requires insurers to cover any other services that are necessary to get the coronavirus test, but doesnt define what makes the cut. Most experts agree that a doctor visit fee is a pretty clear example of a service that ought to qualify, and that patients facing those types of bills ought to appeal to their insurer for coverage. Other services, like a flu test or even an X-ray conducted alongside a coronavirus test, present a murkier situation. If youre facing fees like those, you might want to enlist your doctor to tell the insurer why the additional care was needed.

One last thing to know about the federal laws is that they require insurers to fully cover out-of-network coronavirus tests. This can be especially important for patients who go to an in-network doctor but unknowingly have their sample sent to an out-of-network laboratory, a situation Ive seen many times. Your health plans typical rules for out-of-network care should not apply to the coronavirus test. They can, however, be applied to other parts of the test experience (the doctor visit fee, for example), so it is safer to stick with in-network providers whenever possible.

One other issue to look for is what billing codes your doctor used for the test visit. Many of the surprise bills Ive reviewed involve doctors who charge a visit fee, then send the test to an outside laboratory that submits its own claim. The health plan might apply a co-pay to the doctors visit because its not clearly linked in billing records to the coronavirus test. In this case, you may need to work with your health provider to get your visit recoded to show a coronavirus test occurred.

Nearly everything I know about coronavirus test billing comes from reading the bills that hundreds of Times readers have sent describing their experiences. If you receive a bill related to coronavirus testing and treatment, we ask that you take a moment to submit it here. It will help me continue to report on the types of fees patients face, and can help identify areas of the country where patients are facing unusually high fees.

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Will You Have to Pay for a Coronavirus Test? Here's How to Avoid a Surprise Bill - The New York Times