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 for related costs, some states have worked to make these tests free for anyone who requires them — sometimes under certain conditions. (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 last week. Other similar stories are circulating — in addition to stories about how to get tested, since 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).
Many states have said that coronavirus testing would be free, but that doesn’t seem to be consistently true. Also, 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.
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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.
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 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 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. 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; we are adding data daily, and welcome your contributions.)
At a Congressional hearing on Thursday, 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.
Paying for testing
According to The New York Times, a bill the House of Representatives passed on Saturday “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.” The Senate was supposed to take up such legislation as early as Monday, but President Donald Trump called for changes to the bill to allow for paid sick days for workers in large corporations, and it is unclear when the Senate will take up the legislation.
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.
But 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.The insurance industry’s trade group, 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.
Reining in surprise billing
According to an opinion piece in Sunday’s New York Times titled “This Is One Anxiety We Should Eliminate for the Coronavirus Outbreak,” by David Anderson and Nicholas Bagley, the surprise billing practices common nationwide could have dire consequences during a pandemic. Surprise bills, sent from out-of-network clinics and healthcare providers after a patient goes to an in-network hospital, can bankrupt patients who thought they were playing by the rules.Some states have legislation outlawing such bills, while others do not. And if it’s a self-insured plan, it wouldn’t matter; federal legislation would need to be passed to govern such plans.
”Already, reports of people who have received eye-popping bills for coronavirus testing or emergency room visits are circulating. As these stories proliferate, people will become even more reluctant to get tested or treated when they should,” the op-ed authors argue: “That will obscure the spread of the virus, complicate efforts to adopt measures for social distancing, and lead to unnecessary deaths.”
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.”
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
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 and still has not received back flu test results. After that, if they are negative, he will be tested for COVID. Says he wanted to do the responsible thing and get tested — never expected to be charged, given what he’s heard. He wrote about his experience here, on Reddit, and we reached out to him for details. He has not heard back from his flu results yet. 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. I was asked to consent to proceed with testing (after being there 5 hours) and if I didn’t then I wouldn’t be charged but my test would not be submitted, aka I wasted most of my day. They said someone would call me later to discuss insurance options and options for lowering the cost of this whole process. I consented, as fortunately I can afford the $250, but not everyone can and pressure like that puts people in a tough decision making spot.”
New York 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. “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.’”
Colorado tests for free, but ancillary costs? That’s a question.
“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 orders insurers to cover costs
“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. “The California Department of Insurance and Department of Managed Health Care ordered all full-service commercial and Medi-Cal plans to ‘immediately reduce cost-sharing — including, but not limited to, co-pays, deductibles or coinsurance — to zero for all medically necessary screening and testing for COVID-19, including hospital, emergency department, urgent care and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.’ It also directed them to let their contracted health care providers and customer service agents know of the change. Washington’s state insurance commissioner issued a similar order on Thursday, as did New York regulators on Monday.
“Earlier this week, White House and public health officials sought to reassure Americans that their health insurance, Medicare or Medicaid will cover the cost of testing and treating the new coronavirus. But that won’t encourage people who have no insurance or large deductibles or co-payments to seek help needed to prevent them from infecting others.”
Here is the City of Los Angeles COVID-19 test referral site: https://lacovidprod.service-now.com/rrs.
Michigan says it’s covered
“Michigan health insurers said Friday they will cover the cost of medically necessary tests for the new coronavirus for people covered under employer and individual health plans, while Gov. Gretchen Whitmer announced the waiving of testing and treatment fees for Medicaid recipients,” David Eggert writes for The Associated Press. “Michigan currently has no known COVID-19 cases, but infections have been identified in about half of the states. Plans that will waive copays and deductibles for testing costs include Blue Cross Blue Shield of Michigan, Blue Care Network, Priority Health, CVS Health, McLaren and Meridian, according to the governor’s office. The change will not apply — for now — to large employers that self-insure but use insurance companies to administer their benefits.” Self-insured employers, of course, are covered under federal law, and are exempt from state law.
In Minnesota, too, the self-insured vs. fully insured line is drawn
“Insurers have been offering reassurances that health plans will cover costs related to testing and treatment for COVID-19, but the detail on what that means is variable — and a good illustration of fragmentation in the U.S. health care system,” Christopher Snowbeck writes for The Minneapolis Star-Tribune. “In Minnesota, health plans last week were telling consumers that tests and care for coronavirus illness would be covered according to an individual’s health plan benefits, yet those benefits can include significant out-of-pocket costs in the form of co-payments and deductibles. By the end of the week, some carriers were refining the message by saying cost-sharing will be waived for patients who need the test to confirm coronavirus, but those assurances don’t necessarily extend to large multistate employers with ‘self-insured’ health plans. Plus, cost-sharing waivers for one particular test don’t encompass other types of testing and care patients would probably use.’There are a lot of different ways that people get health insurance in this country, and so it’s hard to make a rapid announcement that will actually put people’s minds at ease,’ said Cynthia Cox, a researcher with the California-based Kaiser Family Foundation, a nonprofit group that tracks health insurance issues. ‘The coronavirus, in many ways, is exposing weaknesses in our health care system, from uninsured rates to high cost-sharing.’”
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