Updated: May 27
Coronavirus tests are supposed to be free, right? That's what the politicians all say, and, in fact, that's what the new laws passed in response to the pandemic are supposed to guarantee.
But, according to health industry experts, that may not really be the case for everyone.
According to the health industry publication Modern Healthcare, many hospitals across America are sitting on hundreds of thousands of bills related to covid-19 tests that may not really be covered. And, those patients eventually may be in for a nasty surprise.
On top of that, apparently the situation is made worse by the lack of sufficient tests in some areas of the country, according to Kaiser Health News (KHN).
Modern Healthcare pointed out that in late March, Congress passed two laws, the Families First Coronavirus Response Act and the CARES Act, that essentially stated that not only does testing have to be covered, but patients shouldn't have to pay a dime. Yet that frequently is not the case, the publication says.
"As many as half of those patients potentially have some out-of-pocket [cost], either for the tests or for companion services with the test," explained Cecelia Moore, chief financial offer at Vanderbilt University Medical Center in Nashville, TN. But, she said VUMC is holding back on sending those bills to avoid backlash of anger from patients surprised by the bills in the midst of the pandemic.
According to Modern Healthcare, the issue comes down to an interpretation of whether the new federal legislation applies to health plans offered by larger employers that use their own money to pay claims as a way to drive down costs. A survey by the Kaiser Family Foundation (KFF) finds a majority of Americans with health coverage are in this type of self-funded plan.
The publication quotes Mike Thompson, CEO of the National Alliance of Healthcare Purchaser Coalitions, as explaining that "the law may have left self-insured employers out of certain elements." Most self-funded health plans, he said, are waiving copays and other bills, but some are not. Some are billing for the test itself and not for the doctor's visit or the related test to rule out the flu.
But Karen Pollitz, a senior fellow with KFF, told Modern Healthcare she disagrees with any idea that patients can be charged.
"It doesn't matter if it's a self-funded plan or a fully insured plan, if you get it from a small employer or a large employer, if you buy it on your own in the marketplace. All private insurance has to cover 100 percent of the cost of covid-19 testing," she told the publication.
Lack of Tests
Meanwhile, patients who are tested for the flu or other potential ailments, but not for covid-19 because of the lack of test kits, can be responsible for the cost of those tests, according to KHN. That's because the guidelines require insurers to cover the cost of an appointment without cost sharing only if the doctor orders or administers a COVID-19 test.
Even if the patient shows symptoms and receives other care related to the novel virus, without a test the patient may be charged for the visit, Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University, told KHN.
“They’re getting a battery of other tests,” said Corlette. “But because there’s not enough [COVID-19] tests, they can’t get this protection.”
So when is a covid-19 test really free?
When it isn't.