By TINA KELLEY and PHOEBE PINDER
(Note: Coronavirus news is changing quickly. We’re updating as warranted.) Coronavirus (COVID 19) testing is making headlines nationwide. Amid a flood of reports of people being charged high prices for testing, or being unable to find testing, there’s a need for reliable information (for a database of test sites, scroll down.)
A Miami resident in this Business Insider story racked up a $3,200 bill, and ultimately didn’t have coronavirus. An actor got a test that wasn’t even processed — and he was charged $9,000, as detailed in this CBS This Morning piece from our partner Anna Werner, the chief consumer investigative reporter at CBS.
In contrast, at a drivethrough testing facility in New Rochelle, N.Y., close to the epicenter of the crisis, testing is free — but restrictions apply. At a hospital in Detroit, people were being charged at least $250 recently. The availability of testing is a big problem (see our blog post here about whether you should get tested, and how to do it — it’s complicated). the CARES act passed by Congress mandates that all private insurance plans cover COVID-19 treatments and tests, and vaccine when it is available. But of course that is complicated by your insurance coverage — treatment is covered, but only at in-network hospitals and subject to your deductible?
“Providers are required to post the cash price for COVID-19 tests on the provider’s public website; noncompliant providers may be subject to civil monetary penalties of up to $300 per day,” the National Law Review notes.
Do you have something we need to know about this? Email us at email@example.com or put your test info into our handy form.
Two kinds of tests
There are two kinds of tests. One is currently the most common — the one that tells whether you actually have coronavirus. That’s usually done with a swab stuck into your nose or elsewhere in the respiratory tract, and the resulting sample is tested at a lab.
Another kind of testing is now being done, serological (blood) testing for the presence of antibodies to the virus. We’ll discuss both kinds here.
Respiratory Testing: Checking to see if you have coronavirus
The first test is for presence of the virus, meaning a current infection. These tests are done by various state, lab and private entities. Access is often restricted: Precedence is given to hospital patients, health care providers, and other front-line workers.
In many early pandemic locations, people who wanted to be tested were asked to certify that they have symptoms, had been exposed to a known case, or met other criteria to get a test. In other words, you can’t just walk in to your doctor’s office and ask for a test — the reason being that the tests are in short supply nationwide.
On Friday, March 20, the New York City Health Department issued a statement saying that — despite a new availability of tests — people should not get tested. “Outpatient testing must not be encouraged, promoted or advertised,” the Health Department said in an advisory.
The New York Times reported: “Facilities were asked to ‘immediately stop testing non-hospitalized patients’ for the virus unless medically necessary. City officials said they were worried the testing centers were drawing sick people out from isolation in their homes. To perform each test, health care workers must use fresh protective gear, including masks, which are already in short supply. The Health Department also discouraged hospitals from testing asymptomatic health care workers, alarming some doctors who believe it could lead to increased transmission within hospitals.”
California also strictly restricted coronavirus testing. In other parts of the country, the situation is less clear.
Across the country, regardless of regulations, tests remain hard to find, according to a New York Times article on March 30. ”Although testing has picked up since a series of setbacks left the United States behind, governors have continued to warn in recent days that their response is still hampered by shortages, including of basic supplies like swabs. Gov. Jay Inslee of Washington, a Democrat, told CNN on Sunday that “we have a desperate need for the testing kits.” And Gov. Ralph Northam of Virginia, also a Democrat, warned last week that there was a shortage of testing materials in his state,” The Times wrote.
Iowa opened a test program in late April, saying it would test everybody. But early reports showed that people who wanted to be tested were consistently turned away. Meanwhile there were multiple reports of outbreaks of coronavirus in meat-packing plants, nursing homes, prisons and elsewhere.
Prices and payer practices vary
Various efforts at the state and federal level to get free testing seem to have had some successes, but the picture is murky.
News reports of people seeking to get tested for COVID-19 and instead incurring flu test visits and costs are spreading. It’s also worth noting that the actual COVID test could be free, but ancillary costs (emergency room, doctor visit etc.) might not be.
In New York, a state-run drivethrough testing site at Glen Island Park in New Rochelle is apparently free, but you have to meet certain restrictions to gain access.
In Florida, one testing site, at Larkin Community Hospital, reportedly was charging $150 a test — while the governor was telling people that testing is free, according to a report from WPLG Local 10 television. See hospital statement at right.
Members of the Kaiser Permanente managed care consortium will receive free testing if referred to it by a member doctor, according to Kaiser’s website. “If you’re diagnosed with COVID-19, additional services, including hospital admission (if applicable), will be covered according to your plan details,” the website says.
Beware of misleading headlines: The cost of a coronavirus swab test ranges from $50 to $100 at LabCorp or Quest, according to Bloomberg News, while the CDC’s test cost $36, according to Axios.com. What’s missing: These entities do not now test individuals on demand, so the information is practically meaningless. Also, these figures usually do not include costs of an emergency room or doctor’s office visit.
For the serological or antibody test, there are two main variants: A hospital (Mount Sinai in New York, for example) is doing a series of tests to see if antibodies are present in the blood of formerly infected people, and what scientific uses there may be for that. These tests tend to be free.
Other tests, outside of a research or hospital setting, seem to be pay-as-you-go. We’ve heard prices as low as $59 and as high as $275.
For a quick checklist of what you can do, see the bottom of this story.
Here’s our data from our reported and crowdsourced “where to find a test site” collection for the swab test. To add your data, go to this link. Story continues below spreadsheet. (Pro tip: If data is not visible, you may need to scroll to the top of the spreadsheet, or left to right; we are adding data daily, and welcome your contributions.)
At a Congressional hearing in March, Rep. Katie Porter (D-CA) got Robert Redfield, the director of the Centers for Disease Control and Prevention, to agree publicly to provide free testing to all Americans, The Washington Post reported. She used figures showing that full testing costs $1,331 for an uninsured person, including, she said, out-of-pocket costs for an emergency room visit. But the results of this conversation remain to be seen. This took place before the serological test came on the scene, so pertains only to the swab test.
Paying for testing
According to The New York Times, a bill the House of Representatives passed “requires private health insurance plans to provide free coronavirus testing and waives cost-sharing rules for testing provided to people covered by Medicare, Medicaid and federal retirement programs. Another $1 billion is provided to test people without health insurance. It boosts federal matching funds to state Medicaid programs by 6.2% to ease the financial strain on states.”
Some states have issued rulings that testing must be covered by insurers. But large corporations with self-funded insurance plans are governed by Federal regulations, not state regulations, so it is not clear if they will cover testing, absent a federal law. CIGNA has agreed to extend free testing to people with such plans, according to ModernHealthcare.com.
Such decisions will be made company by company. According to the Morning Consult, each health insurance provider is coming to its own decisions about how coverage for beneficiaries might vary, according to a spokesperson for the trade group America’s Health Insurance Plans, and the responsibility rests on individuals to make sense of how their plan is handling the outbreak.
Different jurisdictions have different regulations for whether you should be tested or whether you even can be tested (see our post here) given the current scarcity of testing opportunities and the need to focus on those most at risk. America’s Health Insurance Plans, issued a broad statement assuring coverage — but that does not mean that you will be covered by your insurance for all costs — it is a statement by a trade group, and not a guarantee of coverage.
“The Medical Board of California is looking into physicians selling COVID-19 tests while sick people around the country can’t get tested because of a nationwide shortage, a board spokesman said Monday morning,” according to The Los Angeles Times. “The inquiry comes after The Times reported that ‘concierge’ doctors who cater to rich people and celebrities have been selling testing to patients and their families, in some cases even if they have no symptoms or any other reason to be tested. Dr. Jay Gordon, a Santa Monica pediatrician, told clients who purchased the tests for $250 each — to be taken at home with a cheek-swab and then sent to a lab to process results — to save the tests until they’re feeling sick.”
We generally use the Medicare price as a baseline for comparing private costs. According to Medicare, tests the CDC developed will cost $35.92, and those developed by other labs will cost $51.31.
Federal discussion of costs
The Centers for Medicare and Medicaid Services (CMS) released a frequently-asked-questions document outlining how Essential Health Benefits generally include coverage for the diagnosis and treatment of COVID-19, but that “the exact coverage details and cost-sharing amounts for individual services may vary by plan, and some plans may require prior authorization before these services are covered.” Some insurers have said they will cover all testing, but the picture is still murky.
Medically necessary isolation and quarantine in a hospital setting is generally covered under such benefits, though again, specifics may vary by plan.
Quarantine outside of a hospital setting (such as self-isolating at home) is not covered, but other medical benefits prescribed by a medical provider, such as home health care, may be covered, but may also require prior authorization or be subject to certain limitations.
Hawaii, Detroit and Cleveland. Also Illinois.
A Hawaii man said on Facebook (and in our coming database) that he was tested at a local non-profit clinic because of symptoms. “It cost me the price of a regular doctor’s visit via my insurance. They first tested for general flu (negative) and then tested for COVID-19,” he said.
University Hospitals in Cleveland said it would cover testing free, with no co-pays, with a doctor’s orders and under certain other circumstances. See here on the hospitals’ site. But the chance that one might get charged still exists, it seems.
Flash Kowaleski is 30, lives in Livonia, Mich., and is a software project manager. He had symptoms and went to Beaumont Hospital in Detroit, to a drive-through line. He thought it was going to be free, but he’s now out $250. Here’s part of what he wrote on Reddit.
“Just personally experienced the Covid-19 testing process in Michigan USA, and it wasn’t a great experience.
“I am showing symptoms of being sick (cold like symptoms; congestion and fever) and was encouraged to get tested by others. I heard Beaumont in Dearborn, MI had drive through Coronavirus testing so my brother and I drove over there. We arrived just after 3pm and I did not get tested until 7pm. …Even though we live together and he was in the car with me the entire time, he was not allowed to get tested. I was told that my symptoms technically weren’t enough to get tested (99.7 degree fever isn’t a fever, 100+ is, and the only positive cases they’ve had there were both struggling to breathe) but they were still willing to test me. They informed me that I would be tested for the flu and then, if that comes back negative, Covid-19….The process seemed reasonable enough to me. (We’ll come back to this later)
“After getting tested we waited another hour for discharge. On the surface this seems like a pretty standard hospital wait time. But then the kicker came…
“Just prior to discharge I was told I will be charged $250 for this process. I was confused because I’ve been hearing all about how testing is being made free to all Americans with symptoms. It was explained to me that the Emergency Room visit and Flu test are not the Covid-19 test so I owe money for those services.”
Here’s information about testing in Illinois, from the Department of Public Health.
New York respiratory testing
“Gov. Andrew Cuomo announced Monday that New York health insurers must waive any cost sharing associated with novel coronavirus testing so that people are not financially deterred from visiting their doctor’s office, urgent care or an emergency room,” Casey Leins writes at U.S. News and World Report, regarding the respiratory testing. “According to the Democratic governor’s office, residents covered by Medicaid also won’t be expected to pay a co-pay for testing. The news came a day before New York confirmed its second case of the coronavirus.
“We have the best health-care system in the world, and we are leveraging that system including our state-of-the-art Wadsworth testing lab to help contain any potential spread of the novel coronavirus in New York,” Governor Cuomo said. “Containing this virus depends on us having the facts about who has it – and these measures will break down any barriers that could prevent New Yorkers from getting tested.’”
For serological or antibody testing, New York set up a program to test for the presence of antibodies, but it’s limited in scope (see below).
Colorado and California
“When a Denver woman spiked a high fever and felt extreme fatigue, she and her husband did what they figured was the right thing: They called their insurance company’s nurse line to find out if she needed to go to a hospital, chose one that was in network and went to find out if she needed to be tested for the new coronavirus,” Meg Wingerter writes in The Denver Post. “Then the bill came: $4,449 for an emergency room visit and a lab test, which established her symptoms were coming from seasonal flu rather than COVID-19, the disease caused by the new virus that’s raising alarms globally. The woman asked not to be identified because she was worried about repercussions at work. Her husband, Kevin Gabelman, said they took the symptoms seriously because she works with children, meaning there were lots of opportunities for her to be exposed to viruses, or to pass them on to others. While they have insurance, they had to pay about $3,500 out of pocket to meet their deductible, even though she didn’t get any treatment other than advice to go home and rest, Gabelman said. … Colorado’s state lab does COVID-19 testing for free, and Vice President Mike Pence also announced the federal government would treat testing for the new virus as an ‘essential health benefit’ that insurance must cover under the Affordable Care Act.
Neither the state nor federal actions address other costs like copays to see a doctor, emergency room fees, or tests to rule out more common illnesses, like the flu.”
“California on Thursday became the latest state to order insurance companies to waive out-of-pocket costs for coronavirus testing,” Kathleen Pender writes for The San Francisco Chronicle.
Here is the City of Los Angeles COVID-19 test referral site: https://lacovidprod.service-now.com/rrs.
Serological or antibody testing: Checking to see if you were exposed
There’s a lot of talk about serological tests, sometimes called antibody tests, that can show immunity from the virus. But do these tests work? Here’s what you need to know.
Serological tests measure the amount of antibodies present in the blood in response to a particular virus – in this case, SARS-CoV-2, the virus that causes COVID-19. The presence of antibodies in the blood indicates a prior infection. These antibodies for SARS-CoV-2 seem to typically appear within the second week after onset of symptoms, making this type of testing ideal for detecting prior infection, according to the World Health Organization. Nasal swab tests, by contrast, seek to detect active infections.
Researchers hope that antibody tests be more accurate than the nasal-swab tests, and also that they could help provide a clearer sense of the number of asymptomatic coronavirus cases in the country.
The situation is complicated by the fact that the nation – and the world – is in a panic. Public health officials, businesses, and ordinary people are looking for answers in an uncertain situation, hoping for a test that has a definitive answer. But experts disagree on how accurate the tests actually are, and caution on relying too heavily on serological testing at this stage in the pandemic.
For details on how the antibody tests work, and whether they work, see our full post here.
Here’s our data from our reported and crowdsourced “where to find a test site” collection for the serological or antibody test. To add your data, go to this link. Story continues below spreadsheet. (Pro tip: If data is not visible, you may need to scroll to the top of the spreadsheet, or left to right; we are adding data daily, and welcome your contributions.)
In late April, the New York State Health Department began a large-scale study, using serological testing (blood antibody testing) to analyze 3,000 people across the state in order to determine what percentage of New York’s population has actually had COVID-19. “That will tell us, for the first time, what percent of the population actually has had the coronavirus and is now at least short-term immune to the virus,” Governor Cuomo said during a press briefing. (https://www.ny1.com/nyc/all-boroughs/news/2020/04/21/new-york-begins-antibody-testing-of-thousands-to-gauge-infection-rate) “Any plan that is going to start to reopen the economy has to be based on data, and that means it has to be based on testing. This is a new world for all of us.”
Temporary testing sites were set up in 20 grocery stores scattered throughout the state, including at least one in each borough of the city. Consenting grocery store patrons were selected at random to provide fingerstick blood samples to be submitted for serological testing. The grocery stores say they do not plan to continue to provide testing after the study’s completion. The samples will be tested by Wadsworth Center, a state-run lab in Albany. (https://www.marketwatch.com/story/new-york-begins-widespread-random-antibody-testing-but-questions-remain-about-effectiveness-and-immunity-2020-04-20) The test being used was developed by the Wadsworth Center and has received emergency FDA authorization.
Weill Cornell Medicine, Columbia University Irving Medical Center, and NewYork-Presbyterian are looking for plasma donors to potentially help those currently suffering from COVID-19. In order to donate, you must meet the following criteria:
-”Have had a previously confirmed diagnosis of COVID-19 made through testing of a nasopharyngeal swab, oral swab, or sputum (spit).
-Recovered fully from COVID-19, showing no symptoms for at least 14 days.” (https://www.nyp.org/covidresearch)
Mount Sinai Laboratory received emergency use authorization from the (FDA) for an antibody test that was developed, validated, and launched at Mount Sinai. https://www.mountsinai.org/about/newsroom/2020/mount-sinais-blood-test-to-detect-antibodies-to-covid19-receives-emergency-use-authorization-from-us-food-and-drug-administration-pr
Mount Sinai is testing people to give plasma, too. The web form to fill out to gain access is here; it says “If you had COVID-19 and have recovered you can help save a life. Your blood may contain antibodies that fight the virus and can help critically ill people. Mount Sinai is looking to screen you as a volunteer. Please fill out this form to see if you are eligible.”
New York Blood Center is also seeking convalescent plasma donors who have recovered from COVID-19. They say that they do not test for COVID-19. (https://www.nybc.org/donate-blood/covid-19-and-blood-donation-copy/)
A Westchester woman got this email from her primary care provider in late April: “Quest antibody testing: We have just received more information regarding the Quest laboratory serum testing for antibodies:
1) they are not yet sure if it’s covered by insurance. if not, you will be charged by them $169 for the test. They also don’t seem to have a timeline as to when they will find out if it’s covered or not. I think it all depends on when FDA approves the testing. Now it has “emergency use approval” only. However, about 10 days ago, the Center for Medicare and Medicaid Services (CMS) is requiring private insurers to waive out-of-pocket costs for antibody testing for Covid-19 so we are hopeful it should be covered.”
Several companies have offered or promised home testing kits. At this point, according to The New York Times, the FDA has not approved any home testing kits, and at least two of the companies promising them — Nurx and Carbon Health — have withdrawn their offerings.
The Times’s full story is here.
Paying for treatment
And that’s just the test — never mind the treatment. It’s not possible to predict what treatment will cost. In the easiest cases of positive testing, home quarantine seems to be fine, with fluids and fever reducers like acetaminophen.
But people are reporting some very high treatment bills. Time magazine reported on one woman who had treatment.
“Askini saw her temperature spike and drop dangerously, and she developed a cough that gurgled because of all the liquid in her lungs. After two more trips to the ER that week, Askini was given a final test on the seventh day of her illness, and once doctors helped manage her flu and pneumonia symptoms, they again sent her home to recover. She waited another three days for a lab to process her test, and at last she had a diagnosis: COVID-19,” Abigail Abrams wrote. A few days later, Askini got the bills for her testing and treatment: $34,927.43. I was pretty sticker-shocked, she says. ‘I personally don’t know anybody who has that kind of money.'”
In Japan, it costs $166
Meanwhile, Japan’s health ministry said recently that it expected the test to cost the equivalent of $166.
The national hotline for coronavirus is here: 1-800-525-0127. Who should call? People who have symptoms or have been exposed to a case. There are also local and state health departments.
What you can do
1. If you’re uninsured, call your state health department. There may be other resources, so keep asking elsewhere.
2. If you’re insured, call your insurer and get assurances of what will be covered, if you think you have the luxury of time to do so.
3. States and cities vary greatly. New Rochelle, N.Y. is the site of a drive-up test clinic, where we understand the costs are covered by New York State. See details here.
4. This picture is changing rapidly. There is an effort at the national level to have everything covered for everyone, but as always your mileage may vary.
5. In most cases, drive-by testing like what’s being done in New Rochelle, Denver and Detroit is done to keep people from going to a hospital or another place that is unprepared to do this kind of testing. Chances are that it’s free, but the picture is changing rapidly and varies greatly by location.
6. Not sure how to even go about getting the test? You’re not alone. We’ve collected a bunch of data. See our post here.
The national hotline for coronavirus is here: 1-800-525-0127.
Two medical institutions in Connecticut have set up telephone hotlines for people of Fairfield County who are experiencing symptoms that they are concerned could be linked to the coronavirus, according to the New Haven Register:
Norwalk Hospital: 888-667-9262 / 8 a.m. to 6 p.m. Monday to Friday.
Stamford Hospital: 203-276-4111 / 7 a.m. to 7 p.m. Monday to Friday.
Massachusetts essential services
Jeanne Pinder is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded ClearHealthCosts.
She was previously a fellow at the Tow Center for Digital Journalism at the Columbia University School of Journalism. ClearHealthCosts has won grants from the Tow-Knight Center for Entrepreneurial Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York; the International Women’s Media Foundation; the John S. and James L. Knight Foundation with KQED public radio in San Francisco and KPCC in Los Angeles; the Lenfest Foundation in Philadelphia for a partnership with The Philadelphia Inquirer; and the New York State Health Foundation for a partnership with WNYC public radio/Gothamist in New York; and other honors.
Her TED talk about fixing health costs has surpassed 2 million views.