POST 86. December 9, 2020. If this analysis seems a bit incomprehensible it is because “free Coronavirus test” is often an oxymoron! with charges ranging from as little as $23 to as much as $2,315… Laws (like for free Coronavirus tests) are Like Sausages. Better Not to See Them Being Made.

Federal law requires health insurers to cover the costs of enrollees’ coronavirus tests, but some insurers are reporting that those costs vary among states, labs, and providers—with charges ranging from as little as $23 to as much as $2,315…

FDA has approved more than 90 manufacturers’ tests for the new coronavirus, and health insurers are reporting that the amount they are charged for those tests can vary widely.

According to the New York Times’ “The Upshot,” most providers charge insurers between $50 and $200 for the tests, and an analysis of Castlight Health data on almost 30,000 bills for coronavirus tests found that 87% of the tests’ costs were listed as $100 or less….

LabCorp, one of the largest diagnostic testing companies in the United States, has said it bills insurers $100 for coronavirus tests, which is the reimbursement amount that CMS has set for coronavirus tests covered by Medicare…

For instance, Blue Cross and Blue Shield of Texas has gotten more than 600 bills listing out-of-network charges for coronavirus tests as more than $500, with the average costs of those charges at $1,114, “The Upshot” reports. In addition, insurers have flagged that a chain of EDs in Oklahoma and Texas have charged them $500 to $990 for coronavirus tests, according to “The Upshot.”..

“If you are an out-of-network lab, you can name your price,” said Loren Adler, an associate director at the U.S.C.-Brookings Schaeffer Initiative for Health Policy. “I could say it’s $50,000, and you are required to pay me that amount.”

Although the federal government has largely protected patients from being charged for coronavirus tests directly, Americans may wind up paying for the tests in the form of higher insurance premiums, “The Upshot” reports.

Further, labs and providers could perform additional tests intended to diagnose respiratory illnesses, such as the flu, while also testing for the new coronavirus, and charges for those tests could be passed along to patients via their co-payment requirements or deductibles.

In addition, Americans enrolled in private individual health plans or employer-sponsored coverage may be required to cover some costs for the coronavirus tests via their copay or deductible requirements, though many insurers have announced that they will not pass costs for coronavirus testing and care along to their members—at least temporarily, USA Today reports.” (A)

“Some cities, such as Washington, D.C. are offering free coronavirus testing for people who’ve attended protests. Where free tests aren’t available, some people may find insurance refuses to cover precautionary testing.

In the wake of the massive turnout at anti-racism demonstrations around the country, public health officials are encouraging protesters to get tested for the coronavirus. As purely precautionary testing has become more common, some insurance companies are arguing they can’t just pay for everyone who’s concerned about their risk to get tested…

The Families First Coronavirus Response Act passed by Congress requires health plans to fully pay for testing deemed “medically necessary.” But as testing expands enough to allow people without symptoms to be tested, a gray area is beginning to appear.

The coverage mandate can be up to interpretation.

“This is a very live and active debate right now,” says health policy research professor Sabrina Corlette of Georgetown University.

“That requirement may only apply if you’ve been referred for a test by a health care professional after presenting with symptoms of the disease,” she says.

The guidance from the Centers for Medicare and Medicaid Services says full coverage is required “when medically appropriate for the individual, as determined by the individual’s attending health care provider in accordance with accepted standards of current medical practice.”…

The Equal Employment Opportunity Commission has issued guidance saying employers can legally require testing. Still, most businesses aren’t taking their coronavirus precautions that far. Employment attorneys say they’re settling for temperature checks and questionnaires about symptoms and exposures.

But at least one industry is already staring down this dilemma of who pays — long-term care. Nursing home staffers in many states are required to be tested every week. In New York, it’s twice a week, and health plans are beginning to balk.

One-time testing wouldn’t be that big of an expense, though even that would add up across hundreds of employees at roughly $100 per test…

Public health researchers emphasize the importance of regularly testing nursing home residents and employees, as well as other asymptomatic, but high-risk people, and making testing available to people who may have been exposed at events like protests. This can help catch undetected disease and stop it from spreading in a community.

Many cities are offering to fund the precautionary tests for people who’ve attended protests. Still these free tests aren’t available everywhere and since most states are not yet paying for testing (though Tennessee is) many people are left relying on their private insurance.” (B)

“As she waited for the results of her rapid COVID-19 test, Rachel de Cordova sat in her car and read through a stack of documents given to her by SignatureCare Emergency Center.

Without de Cordova leaving her car, the staff at the freestanding emergency room near her home in Houston had checked her blood pressure, pulse and temperature during the July 21 appointment. She had been suffering sinus stuffiness and a headache, so she handed them her insurance card to pay for the $175 rapid-response drive-thru test. Then they stuck a swab deep into her nasal cavity to obtain a specimen.

De Cordova is an attorney who specializes in civil litigation defense and maritime law. She cringes when she’s asked to sign away her rights and scrutinizes the fine print. The documents she had been given included disclosures required by recent laws in Texas that try to rein in the billing practices of stand-alone emergency centers like SignatureCare. One said that while the facility would submit its bill to insurance plans, it doesn’t have contractual relationships with them, meaning the care would be considered out-of-network. Patients are responsible for any charges not covered by their plan, it said, as well as any copayment, deductible or coinsurance.

The more she read, the more annoyed de Cordova became. SignatureCare charges a “facility fee” for treatment, the document said, ranging “between five hundred dollars and one hundred thousand dollars.” Another charge, the “observation fee,” could range from $1,000 to $100,000….

As she waited, de Cordova realized she didn’t want to play insurance roulette. She changed her mind and decided she’d pay the $175 out-of-pocket for her test. But when the SignatureCare nurse came to collect the paperwork, de Cordova said the nurse told her, “You can’t do that. It’s insurance fraud for you to pay for our services once we know you have insurance.”Unable to pay cash and unwilling to take a chance on the unknown cost, de Cordova decided to leave without getting the results of her COVID-19 test…

“I Would Have Signed Anything”

Later that day, de Cordova couldn’t get past what happened. She wondered what happened to patients who didn’t read the fine print before signing the packet.

Then she realized she and her husband, Hayan Charara, could investigate it themselves. In June, the couple’s 8-year-old son had attended a baseball tryout. They thought the kids would be socially distanced and that precautions would be taken. But then the coaches had crowded the players in a dugout, with no masks or social distancing, and a couple days later the boy said he wasn’t feeling well.

Charara, de Cordova and their children are covered by the Employees Retirement System of Texas, a taxpayer-funded benefit plan that covers about half a million people. They hadn’t received any notices about the charges for their son. So they contacted the SignatureCare billing department and asked for an itemized statement. The test charge was indeed $175. But the total balance, including the physician and facility fees associated with an emergency room visit, came to $2,479.

The facility fee was $1,784 and the physician fee $486.

The couple were dumbfounded. Their son’s vital signs had been checked but there had been no physical examination, they said. The interactions took less than five minutes total, and the child stayed in the car. “You’re getting a drive-thru test, and they’re pretending like they’re giving you emergency services,” de Cordova said…” (C)

“Covid-19 tests are supposed to be free for anyone who has insurance, but unexpected bills from doctors’ offices and hospitals remain a big concern, researchers say. Employers who want to prevent outbreaks among their employees are increasingly paying for tests, and some say those expenses are only growing.

How much the test costs depends on who offers it, as hospitals, laboratories, and doctors’ offices all set their own prices. The same test one clinic charges $50 to perform could cost $5,000 at a hospital, researchers who study billing practices say.

“It seems to us to be totally and completely random what they charge,” said Gerard Anderson, a professor of health policy at Johns Hopkins University who is studying hundreds of hospital charges for Covid-19 tests.

Increasing the number of Covid-19 tests is key to containing the spread of the coronavirus and keeping businesses open until a vaccine for virus is developed and distributed widely, public health officials have said. Almost 1.2 Americans applied for unemployment benefits last week as a large portion of the U.S. economy still struggles with the virus.

For one of the most common Covid-19-related tests, the swab-in-the-nose that can take days to see results, health-care providers charge on average $63 and facilities collect on average $372, insurance claims data from the nonprofit FAIR Health show. Hospitals and health systems are generally charging more than doctors’ offices, Anderson said.

Large hospitals charge between $20 to $850 for a single test, an analysis by the Kaiser Family Foundation found. Anderson said he saw a single charge from a Texas hospital for $5,000 for a Covid-19 test.

There’s been as many as 900,000 new Covid-19 tests performed in a single day in the U.S., although in recent weeks that figure has dipped below 800,000 new tests per day, according to Bloomberg News data. Some public health experts have suggested the U.S. needs to perform as many as 3 million tests per day in order to contain the virus.

Some industries say they’re covering their employees’ tests but worry about how the costs are adding up as the virus spreads through the summer.

In California, builders and contractors were deemed essential businesses and allowed to continue operating even as Covid-19 cases were growing rapidly earlier in the year. Some companies tested their employees whenever one of them was potentially exposed to the virus and occasionally wound up paying add-on fees for on-site testing or high prices for the tests, Michele Daugherty , president and CEO, Associated Builders and Contractors Northern California, said.

An outbreak among workers can cripple a contracting company, which employs skilled workers who aren’t easily replaced, and the industry is worried that if they can’t keep the virus at bay the state will stop allowing them to work, Daugherty said. The cost of the tests so far is easier to take on than losing weeks or months of work, she said.

“We look at it as our responsibility,” she said. “That right to work as an essential business could be taken away if there’s an abundance of outbreaks in our industry.”

Daugherty said her organization started setting up testing for construction companies in northern California to help them navigate this uncertain landscape. The group works with PMH Laboratory Inc. to set up tests that cost $125 each, she said.” (D)

Sarah Goldstone got a coronavirus test in Massachusetts after her health insurer said it was “waiving cost sharing for Covid-19 testing-related visits.”

Amanda Bowes, a health policy analyst in Maryland, got hers because she knew a new federal law should make coronavirus testing free for insured patients like her.

Kelly Daisley had one after seeing New York City’s ads offering free tests. “Do it for them,” says one bus shelter ad near her home, showing a happy family.

All three were surprised when their health insurers said that they were responsible for a significant chunk of their bills — in Ms. Daisley’s case, as much as $2,718.

“I had seen so many commercials saying there is testing everywhere, it’s free, you don’t need insurance,” said Ms. Daisley, 47, who was tested at an urgent care center three blocks from her Brooklyn apartment. “If I had to pay it off, it would clear out my savings.”

For months, Americans have been told not to worry about the costs of coronavirus tests, which are crucial to stopping the pandemic’s spread. “It is critical that Americans have peace of mind knowing that cost won’t be a barrier to testing during this national public health emergency,” Medicare’s administrator, Seema Verma, said in April.

Congress passed laws requiring insurers to pay for tests, and the Trump administration created a program to cover the bills of the uninsured. Cities and states set up no-cost testing sites.

Patients, whether with or without insurance, are beginning to find holes in those new coverage programs. Nationwide, people have been hit with unexpected fees and denied claims related to coronavirus tests, according to dozens of bills that The New York Times has reviewed. Insurers have told these patients they could owe from a few dollars to thousands…

Federal law requires insurers to pay for any doctor visit associated with a coronavirus test, specifically noting that visits to urgent care centers are included. It is silent, however, on how much an insurer must pay to an out-of-network facility — although most experts agree a health plan would need to pay something rather than deny the fee…

Experts say federal law requires the insurer to cover the antibody test in full, even out of network. But the rules around the other tests are less clear: The law states that insurers must cover services related to obtaining a coronavirus test but doesn’t identify what type of care makes the cut. Some providers seem to tack on unrelated lab tests. Patients at a drive-through coronavirus testing site in Texas, for example, were unknowingly tested for sexually transmitted diseases. Without clear federal guidance, insurers are left to sift through charges to decide what is related to coronavirus and what isn’t.

Initially, Ms. Daisley was left with more than $2,000 to pay to out-of-network labs: $210 for the antibody test and $2,508 for the other lab services. Her health plan, Anthem, denied the larger charge because her health benefits do not cover out-of-network care.

The insurer covered the charges after The Times inquired. “Seeing as Ms. Daisley was unaware the treating provider would send her samples to multiple out-of-network labs for what she understood was related to Covid testing, Anthem is covering the costs of the outstanding claims,” a spokeswoman for Anthem, Leslie Porras, said.” (E)

“Federal law does not require out-of-network providers to bill insurance directly for COVID-19 tests. Typically, providers that participate in a patient’s health plan network are contracted to bill that patient’s insurance directly. While the law requires coverage of out-of-network testing without cost sharing, patients who seek COVID-19 testing out-of-network may be required to pay up front for services, then submit claims to their health plan for reimbursement. Patients who don’t know how to manually submit out-of-network claims or who are too sick to do so may not succeed.

Federal coverage requirements apply only to individualized diagnostic testing, but not when conducted as part of employee “return to work” programs. Guidance issued by federal agencies states that health plans are not required to cover testing that is “conducted to screen for general workplace health and safety (such as employee “return to work” programs), for public health surveillance… or for any other purpose not primarily intended for individualized diagnosis or treatment of COVID-19…” To the extent employers may expect or require their workers to be tested periodically for COVID-19, private health plans would not be required to cover such testing costs. However, employers that do require periodic testing for workers could choose to cover the cost of testing for their employees.

Federal requirements to cover COVID-19 tests do not apply to all private plans. The FFCRA and CARES Act coverage requirements do not apply to non-ACA compliant plans, such as short-term health insurance policies. Some health insurers and short-term policy issuers have said they will voluntarily waive cost-sharing for COVID-19 tests under all of their policies.” (F)

“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.

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.

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.

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.

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.” (G)

“When Dr. Zachary Sussman went to Physicians Premier ER in Austin for a COVID-19 antibody test, he assumed he would get a freebie because he was a doctor for the chain. Instead, the free-standing emergency room charged his insurance company an astonishing $10,984 for the visit — and got paid every penny, with no pushback.

The bill left him so dismayed he quit his job. And now, after ProPublica’s questions, the parent company of his insurer said the case is being investigated and could lead to repayment or a referral to law enforcement…

During the brief visit, Sussman said he chatted with the emergency room doctor, whom he didn’t know. He said there was no physical examination. “Never laid a hand on me,” he said. His vitals were checked and his blood was drawn. He tested negative. He said the whole encounter took about 30 minutes.

About a month later, Golden Rule sent Sussman his explanation of benefits for the physician portion of the bill. The charges came to $2,100. Sussman was surprised by the expense but he said he was familiar with the Physicians Premier high-dollar business model, in which the convenience of a free-standing ER with no wait comes at a cost…

Sussman felt more puzzled to see the insurance document say, “Payable at: 100%.” So apparently Golden Rule hadn’t fought for a better deal and had paid more than two grand for a quick, walk-in visit for a test. He was happy not to get hit with a bill, but it also didn’t feel right.

He said he let the issue slide until a few weeks later when a second explanation of benefits arrived from Golden Rule, for the Physicians Premier facility charges. This time, an entity listed as USA Emergency sought $8,884.16. Again, the insurer said, “Payable at: 100%.”

USA Emergency Centers says on its website that it licenses the Physicians Premier ER name for some of its locations.

Sussman’s insurer, Golden Rule, agreed to pay 100% of Physicians Premier’s $8,884.16 facility charges for a COVID-19 antibody test. According to Sussman, the materials to make each test cost about $8. (Redactions and highlights by ProPublica)

Now Sussman said he felt spooked. He knew Physicians Premier provided top-notch care and testing on the medical side of things. But somehow his employer had charged his health plan $10,984.16 for a quick visit for a COVID-19 test. And even more troubling to Sussman: Golden Rule paid the whole thing.

Sussman was so shaken he resigned. “I have decided I can no longer ethically provide Medical directorship services to the company,” he wrote in his July 13 resignation email. “If not outright fraudulent, these charges are at least exorbitant and seek to take advantage of payers in the midst of the COVID19 pandemic.”…

The claims also included codes for a nasal swab coronavirus test. But that test was not performed, Sussman said. The physician’s orders documented in the facility’s medical record also do not mention the nasal swab test. Those charges came to $4,989.

The claims show two charges totaling $1,600 for the antibody test Sussman received. In a spreadsheet available on its website on Friday, Physicians Premier lists a price of $75 for the antibody test.

For comparison, Medicare lists its payment at $42.13 for COVID-19 antibody tests. That’s because Medicare, the government’s insurance plan for the disabled and people over 65, sets prices.

Complicating matters, Texas is the nation’s epicenter for free-standing emergency rooms that are not connected to hospitals. Vivian Ho, an economist at Rice University who studies the facilities, said their business model is based on “trying to mislead the consumer.” They set up in locations where a high proportion of people have health insurance, but they don’t have contracted rates with the insurers, Ho said. They are designed to look like lower-priced urgent care centers or walk-in clinics, Ho said, but charge much higher emergency room rates. (The centers have defended their practices, saying that they clearly identify as emergency rooms and are equipped to handle serious emergencies, and that patients value the convenience.)

The day after he resigned, Sussman texted an acquaintance who works as a doctor at Physicians Premier. The acquaintance said the facility typically only collects a small percentage of what gets billed. “I just don’t want to be part of the game,” Sussman texted to him…

The charges for Sussman’s COVID-19 test visit are “ridiculous,” said Niall Brennan, president and CEO of the Health Care Cost Institute, a nonprofit organization that studies health care prices. Brennan wondered whether the CARES Act has made insurers feel legally obligated to cover COVID-19 costs. He called it “well intentioned” public policy that allows for “unscrupulous behavior” by some providers. “Insurance companies and patients are reliant on the good will and honesty of providers,” Brennan said. “But this whole pandemic, combined with the CARES Act provision, seems designed for unscrupulous medical providers to exploit.” (H)

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