How to Avoid a Surprise Bill for Your Coronavirus Test
Get tested at a public facility. Question what services are being provided. And know your rights under federal law.
By
Sarah Kliff
Image
A mobile testing station on Staten Island in New York City.Credit...Stephanie Keith for The New York Times
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.
[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.
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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.
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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.
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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.
To challenge a surprise bill, know your rights under federal law
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 without any cost to the patients. This means that standard deductibles and co-payments you’d face for other services do not apply.
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Those laws also require insurers to cover any other services that are necessary to get the coronavirus test, but doesn’t 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 you’re 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 I’ve seen many times. Your health plan’s 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.
Receive an unexpected bill? Medical codes could be the culprit
One other issue to look for is what billing codes your doctor used for the test visit. Many of the surprise bills I’ve reviewed involve a doctor charging a visit fee, then sending the test to an outside laboratory that submits its own claim. The health plan might apply a co-pay to the doctor’s visit because it’s 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.
Tell us what happened to you. It helps our journalism.
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.
Friends and family are proving to be the real spreaders of this shit, so act accordingly. If they ain't from your household, let them do them. 
