How to Avoid a Surprise Bill for Your Coronavirus Test

More Americans are getting tested for coronavirus than ever before — and that could mean more surprise medical bills.

Congress wrote rules in March that aimed to make coronavirus testing free for all Americans. Patients, with or without insurance, have found holes in those new coverage programs. They’ve faced bills that range from a few dollars to over $1,000.

I’ve spent much of the past four months collecting patients’ bills related to coronavirus. As part of that project, I’ve 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.

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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.

If you can, get tested at a public site

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

If a public test site isn’t an option where you live, you might consider your primary care doctor or a federally qualified health clinic. The largest surprise coronavirus test bills I’ve 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 don’t 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 shouldn’t have to worry about that type of billing. They typically do not charge facility fees for coronavirus tests or any other types of care.

Ask your provider what they’ll bill you for

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

Some of those services make sense. Many bills for coronavirus tests have fees for the doctor visit that went along with it. Others make less sense, like the ones that include screenings for sexually transmitted diseases that have nothing to do with coronavirus. 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 I’m having a coronavirus test. Are there any other services you’ll 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 can’t tell you what they’ll bill for, that may be a signal you want to seek care elsewhere.

Uninsured? Ask your doctor to bill the government, not you

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.

The Coronavirus Outbreak ›

Words to Know About Testing

Confused by the terms about coronavirus testing? Let us help:

    • Antibody: A protein produced by the immune system that can recognize and attach precisely to specific kinds of viruses, bacteria, or other invaders.
    • Antibody test/serology test: A test that detects antibodies specific to the coronavirus. Antibodies begin to appear in the blood about a week after the coronavirus has infected the body. Because antibodies take so long to develop, an antibody test can’t reliably diagnose an ongoing infection. But it can identify people who have been exposed to the coronavirus in the past.
    • Antigen test: This test detects bits of coronavirus proteins called antigens. Antigen tests are fast, taking as little as five minutes, but are less accurate than tests that detect genetic material from the virus.
    • Coronavirus: Any virus that belongs to the Orthocoronavirinae family of viruses. The coronavirus that causes Covid-19 is known as SARS-CoV-2.
    • Covid-19: The disease caused by the new coronavirus. The name is short for coronavirus disease 2019.
    • Isolation and quarantine: Isolation is the separation of people who know they are sick with 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 swab: A long, flexible stick, tipped with a soft swab, that is inserted deep into the nose to get samples from the space where the nasal cavity meets the throat. Samples for coronavirus tests can also be collected with swabs that do not go as deep into the nose — sometimes called nasal swabs — or oral or throat swabs.
    • Polymerase Chain Reaction (PCR): Scientists use PCR to make millions of copies of genetic material in a sample. Tests that use PCR enable researchers to detect the coronavirus even when it is scarce.
    • Viral load: The amount of virus in a person’s body. In people infected by the coronavirus, the viral load may peak before they start to show symptoms, if symptoms appear at all.

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