If COVID tests are supposed to be free, why are some people getting charged thousands of dollars?

covid test cost
Photo via Chris Yarzab/Flickr (CC BY 2.0)

Even with COVID-19 vaccines rolling out across the United States, testing still plays an essential component in curbing the virus’ spread. Under the Coronavirus Aid, Relief, and Economic Security Act (CARES) that President Trump signed into law on March 27, 2020, there should be no COVID test cost. Instead, the tests should be free for all Americans, including the uninsured.

The CARES Act essentially ensures that COVID-19 testing is provided fully at no cost under testing and preventative care provisions. Yet, some people are getting surprised with substantial medical bills, sometimes into the thousands of dollars, after getting their test.

The New York Times recently conducted a survey among readers to submit their healthcare bills to understand better the costs associated with coronavirus testing and treatment. Out of more than 600 patients who participated, their findings revealed high charges and allegedly illegal fees—in addition to COVID-19 patients who now face substantial medical debt for treatment.

Though state and local public health department-run testing sites typically do not charge patients or collect health insurance information for nasal swab tests, the cost of testing at hospitals can run a wide gamut.

A study published by the Kaiser Family Foundation on July 15, 2020, found that large hospitals nationwide were charging anywhere from $20-$850 for a nasal swab test. At some independent laboratories, the costs skyrocketed to as much as $2,315.

The Times zeroed in on one hospital in particular, Manhattan’s Lenox Hill Hospital location in Greenwich Village, which has been charging more than $3,000 for routine nasal swab tests. Until recently, the hospital had been advertising COVID-19 testing on banners outside of its facility, only to charge patients non-transparent emergency room fees that often didn’t show up on bills until months later.

One such patient, Ana Roa, told the newspaper that she was billed $3,358 for a routine swab test at Lenox Hill in February 2021. “It was shocking to see a number like that when I’ve gotten tested before for about $135,” said Roa.

And she wasn’t alone. Another family revealed they had accrued $39,314 for 12 tests over the winter, all required to return to work or school. In yet another of 16 instances that the Times reviewed at Lenox Hill alone, an asymptomatic patient who had just returned from traveling was charged $2,963 for a swab test after seeing the banner outside and walking in.

Emergency rooms in the United States are allowed to charge patients a discretionary “facility fee,” which is essentially what you pay just for walking through the door. These fees, which have spiked in recent years, can range from $200-$1,800, depending on complexity. The Lenox Hill Greenwich Village center bills $671 for its COVID-19 test, on top of emergency room fees—which are typically not disclosed to the patient at the time of the test.

Renee Hsia, a professor of emergency medicine at the University of California-San Francisco who also researches medical billing, told the Times that COVID-19 testing has been a “gold mine” for hospitals because they can charge emergency fees even for asymptomatic, healthy people who just want to get tested.

“This is what you’d expect from a market-oriented approach to health care,” said Hsia. “It’s the behavior our laws have incentivized.”

How can I avoid a huge cost after getting a COVID test?

The good news is that excessive medical bills are the exception, not the rule, and that you shouldn’t let a few horror stories frighten you away from COVID-19 testing.

To avoid getting stuck with a hefty bill, check ahead with your insurance provider to see what’s covered. Ask for a breakdown of charges ahead of time, so there are no hidden fees piggybacked on your testing appointment. And make sure to find out which medical billing code your healthcare provider uses to order the test to ensure it’s ordered correctly.

Medical billing codes refer to the classification system used to identify specific surgical, medical, or diagnostic procedures. Ill patients displaying coronavirus symptoms may require a different billing code than asymptomatic patients. (Websites such as FindACode.com can help people searching for COVID-19 tests know what to ask for when searching for free or low-cost testing.)

As VeryWellHealth points out, many factors can affect your coverage, and it’s important to sort it out ahead of time. If you get surprised with a bill you disagree with, always call the testing facility or appeal to your insurance provider to negotiate any fees that appear suspect.

If you’re uninsured, contact your state or local government to find a free testing site near you or try visiting the Department of Health and Human Services website.

Sources: VeryWellHealth, New York Times

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