Covid testing, which had long been fairly predictable, is becoming unpredictable and pricey, people are finding — making it more important to shop around and be sure of what you’re getting.
This is a $716 issue for A.S., of Pelham, N.Y., mom of children aged 7 and 11. Other Pelham women had trouble too: It was a $600 issue for V.S., a $230 issue for Amanda Hannan, and a $1,000 issue for D.C.
This isn’t the first time we’ve written about this, but here we go breaking down the situation now, in late October — as we suddenly started hearing about a number of people who had complained that they were being charged for a Covid test, which they were certain was supposed to be free.
Same day, $716
A.S. took the entire family, including her husband, to a same-day testing location in Massachusetts while visiting relatives there. They didn’t think of whether it was in or out of network, she said; she understood that all testing was covered per the federal rules of last spring. “To go somewhere else, we would have had to drive an hour or more,” she said.
One of the children had cold symptoms when they arrived, and they were staying with elderly grandparents, so they went to the urgent-care center. She told the center they don’t need the office visit, just tests. “They said we had to do the office visit,” she said.
After a talk with the insurer, she got news that the out-of-network part of the test would be covered, but not the out-of-network part of the office visit: $179 each for all four family members.
Once the bill came, she contested with her insurer. The insurer said “you could have gone to Labcorp and gotten direct tests,” she said, to which she replied, “How would I know that?”
Believing that all the testing was free, she also described an episode in the New York City area where she went looking for a test for an unvaccinated child to attend a Broadway event. The requirement was that an unvaccinated person could not use the rapid test over the counter; she had to go to urgent care. The urgent care center that A.S. went to would do not just the rapid test, but did both the rapid and PCR tests. She still hasn’t seen a bill for that, but she’s apprehensive. (You need a rapid or other test within 6 hours of entering, she said; she looked for over-the-counter tests but could not find them — over-the-counter tests are in short supply in many places — and wound up in the urgent care location.)
Even if it winds up being covered, she said, “The infuriating thing is the stress.” This arguing and back-and-forth takes time, she pointed out. And the insurer tells her to talk to the urgent care, while the urgent care tells her to talk to the insurer. And she’s still up in the air.
Why is this happening?
We have been tracking Covid testing prices since March of 2020. The story is not uniform, but generally: The federal government promised in the spring of 2020 to cover costs for testing, as a way of reducing reasons for people not to get tested. In many places, that worked — at least for a while. But we have had sporadic reports that people are getting charged.
We have heard more reports lately. We have written about this many times, including this piece last summer, and then again this August. We think part of the problem is that testing capacity dropped after May and June, when the United States was feeling pretty good about the vaccine. We did note in August that the number of testing sites seemed to have dropped, that the time to results seemed to have risen, and that the availability of over-the-counter tests had also dropped. All those things seem to be even more true now, in October, with the return to school, return to the office and the surge (maybe now dropping, at least in some states) of Delta.
We did a deep dive in testing in San Diego earlier this year, which was posted in May, and found a range of charges: Anywhere from $0 to $400.
We wondered if something had changed in the law that so many reports of testing charges were coming our way. This is the latest federal guidance on the FFCRA/CARES Act testing coverage mandate, according to Sabrina Corlette, a Georgetown University professor who studies insurance and the health care system.
“Nothing has changed recently in terms of federal guidance, but I have noticed that many state- and locally funded testing sites have stopped operating, or significantly reduced availability,” Corlette, wrote in an email in response to my question. “Which means more tests are being done by private providers, which leads to people being charged.”
She noted that the current federal guidance on the Families First Coronavirus Relief Act (FFCRA), which was amended by which was amended by the Coronavirus Aid Relief and Economic Security Act (CARES), for testing coverage is here.
“Note that the federal mandate only applies to health plans and issuers. There is nothing in federal law that prevents a provider from charging a patient for a test. (This is very different from the federal rules on the vaccine, which prohibit providers from charging anyone.)”
She added: “It is important to note that in many if not most cases, people who get charged up front for testing services should be able to get reimbursed by their insurer. Although insurers don’t always make it easy to submit bills for reimbursement. If someone gets a bill from a provider after the test was performed, they should contact their insurer first before paying it.”
Billing advocate: ‘Pick up the phone’
Susan Null, medical bill advocate at Systemedic, Inc., in New City, N.Y., agreed that the law has not changed. She said that she is seeing a pattern: The provider or insurer will try to get the patient to pay.
“If they tack on an office visit, the cost is going to creep up,” she said in a phone interview. “But if it’s just the test itself, it’s often not thousands of dollars. So I think that these companies are relying on the fact that people aren’t going to fight them, because it’s not worth it to them for the amount of money. Just like we’ve seen all along, process a claim the way you want to process the claim, and know that 80% of people will do nothing about it. So you only have to really deal with the 20% who are going to make some noise about it.
“You can’t let your guard down, whether it’s Covid or anything else. People have to ask the questions in advance, or they’re going to potentially pay the price. Maybe that $179 is not going to break me, but it’s the principle. So how many hours is that person going to spend fighting it to get it?”
The law “clearly states that you shouldn’t have to lay out a penny for it,” she said, but she has also seen cases where people are asked to pay.
“The first thing you do is pick up the phone and call them and say ‘Why are you doing this? You know this is supposed to be paid,’ and if necessary get the provider and the insurance company on a three-way conversation with you and make them talk to each other,” she said. “Because if you say ‘call my insurance company’ or ‘call my provider,’ it doesn’t get done — it goes to the file someplace and nobody pays attention to it. But if you force them as the policyholder — say ‘you need to fix this and I want a conference call on it,’ they have to do it and then and then maybe you can get it resolved. But to let it go and make the assumption they will fix it is the case for disaster. You’ve got to speak up when it first happens and not wait, because the longer you wait the harder it is to get somebody to want to fix it.”
A 2-year-old and a bill
Amanda Hannan of Pelham argued over a bill and got it repealed.
She said in a phone interview that she took her 2-year-old to Westmed at Ridge Hill in Westchester County in late August or early September because he is in day care, and he had a slight runny nose, postnasal drip and a little cough. Before going to day care, she said, “in an abundance of caution,” she went for the test. After the nurse tested him, she said, the staff asked her to stay and see a physician assistant, who told her to give her son Benadryl and Robitussin. She said “are you sure?” because he is only 2 years old. The P.A. said “Oh, right, I don’t do peds,” and left the room.
She then received a bill for $230, billed as an urgent care visit although when she made the appointment online, she specified it was for a Covid test. Since she hadn’t met the deductible, she was billed.
She called the billing department and talked to a woman who said she’d call back the same day — but Hannan never heard back. Then she called another time, she said, and was told “it will be taken care of in the coding department — it’s federally funded.” Then she got another threatening letter, saying she needed to pay.
“I’m definitely not paying it,” she said. “I wouldn’t mind if first off, they let me know that they were going to charge me for an urgent care visit, because I signed up online for the Covid test. The second thing is if she actually examined him, you know, and provided some sort of a care, maybe I can see paying for her time, but since she just gave me advice that I can’t even use, I think it’s ridiculous.”
After we spoke, she looked at the Westmed portal and saw that the bill had been zeroed out.
A charge that may now have been repealed
V.S., who also lives in Pelham, was not feeling well before Labor Day — and she was about to go on vacation. So she looked on the New York State approved site for testing and found a CityMD location in Eastchester. She went to visit, told of her symptoms, and got a negative rapid test — then a PCR test after that.
She received an explanation of benefits at the end of September saying that this was an out-of-network provider, and that both she and her husband, who went with her, would be responsible for $300 each. (Both had covid in March 2020, and both are now fully vaccinated.)
She called Blue Cross Blue Shield, her insurer. “The girl i spoke with told me there was a mistake and they were billing us for a diagnosis, when they should have been billing for covid in which case there is no copay,” she said. She was told to send am email to Blue Cross explaining, and that would settle it.
Two weeks later, she called back — and the representative told her the charges were not for Covid testing, but for a diagnosis because the facility was out of network. She was further informed that she was responsible for failing to do due diligence. That rep promised to get back in two or three days, V.S. said.
She didn’t call back, so V.S. called and her call was forwarded to the claims department — which told her the bill was in error, CityMD was indeed in network, she would not receive a bill for Covid testing, but she would have a $30 copay for the visit. She said it would take 30 days to resolve.
She said she thought this would in fact remove the worst charges.
Another one, this time for a child
Another Pelham mom wrote on social media: “Make sure your insurance will be covering your bill! Our blue cross blue shield insurance is not covering both of my girls pass August covid test! We have $500 bill for each kid! They claimed the urgent care I went is not part of their network.”
One, child, 11 years old, went to a ballgame with a vaccinated family in early August. A few days later, the mom in the family called to say they were all positive for Covid. A day or two later, the 11-year-old had a runny nose. Mom called around to find a quick appointment, but many sites offered a significant delay. So she ended up taking her daughter to a Mount Vernon urgent care site to get her tested quickly. “We got a list of places and I tried to call — but they only had like to make an appointment with two days later and I need them right now because I don’t want to get more people infected,” she said.
That child was positive. They tried to quarantine in the family, but a few days later, a 14-year-old also had symptoms. She went to the same urgent care to be tested, and she, too, was positive.
At a later date, $500 bills for both girls came. The urgent care center said they were out of network, so they’d have to pay.
So, what can you do?
Here are some suggestions:
- Ask in advance: Is this covered by my insurance? Or what will my out-of-pocket be at this provider with this insurance? One woman wrote on Facebook: “Specifically asked if they would bill for the test only or for a full urgent care visit. Walked out of 2 urgent cares that said they would only do the test if they billed for the visit. I found a third that bills the test only. “
- Ask: Will I be charged for an office visit or anything else?
- How much will that office visit or extra charge be? And will it be covered by my insurance?
- Can I have that in writing? Take notes, take names, take numbers.
- Sometimes as in the rest of health care, you can get an explanation of benefits that suggests you’ll need to pay — but maybe it hasn’t fully been processed by both provider and insurer, so you don’t owe. For many people, arguing with the provider and insurer is something they delay doing. What Null recommends: Jump on it right away, call the provider and the insurer, and get them on the phone for a conference call immediately.
“People have to learn to advocate for themselves, because the squeaky wheel gets the grease,” Null said.
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.