How to avoid a surprise bill for virus 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 orwithout insurance, have found holes in those new coverage programs. They’ve faced bills that range from a few dollars to over $1,000.
The surprise bills have hit uninsured Americans as well as those with robust coverage. 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, cities and towns now have public testing facilities. Very few patients have reported surprise medical bills from those testing sites, although it’s not impossible. You typically can 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 the Times 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 drivethru coronavirus tests. A patient in NewYork faced a $1,394 charge for her test at a tent outside a hospital. Themajority of the bill was
the facility fee.
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.
Many bills for coronavirus tests have fees for the doctor visit that went along with it.
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 actually is needed. If your providers can’t tell youwhat 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.
To challenge a surprise bill, know your rights under federal law.
The new laws state that health insurers must cover coronavirus tests without any cost to the patients. This means that standard deductibles and copayments you’d face for other services do not apply.
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 outof-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 outof-network laboratory. Your health plan’s typical rules for outof-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.
Many of the surprise bills 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 copay to the doctor’s visit because it’s not clearly linked in billing records to the coronavirus test. In this case, youmay need to work with your health provider to get your visit recoded to showa coronavirus test occurred.