The Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security Act (CARES) requires insurers to cover the cost of COVID-19 testing for members without cost sharing. If a provider finds a COVID-19 test medically necessary, CARES requires insurers to cover any fees with getting a test in an emergency room, urgent care center or doctor’s office, according to Healthcare Dive.
In practice, however, gaps have appeared where patients are stiffed with bills. Depending on one’s interpretation, the law may not apply to self-funded employers. In addition, to avoid balance billing, patients must see in-network providers.
Representative Katie Porter of California faced balanced billing herself. She was left with a $56.60 bill after getting a COVID-19 diagnostic test, even though her insurer had waived cost-sharing. Porter said, “It is simply outrageous and unacceptable for the administration to promise that patients will not bear the brunt of coronavirus testing and then fail to take the actions necessary to fulfill that promise.”
The experience has prompted Porter to call on the Departments of Health and Human Services (HHS) to issue “explicit guidance and enforcement consequences for states, payers, providers and testing companies to ensure patients don’t get put on the hook for COVID-19 bills” in accordance with the Families First Coronavirus Response Act and CARES, Healthcare Dive reported.
Even as stay-at-home orders deescalate in most areas, cases are increasing in parts of the South and West. The question of who pays for a test, therefore, is unlikely to disappear anytime soon.
Providers have not been able to answer the question either. For example, the Vanderbilt University Medical Center has held back more than $6 million in COVID-19 testing billing since March, according to Kaiser Health News. The Center’s vice president of revenue cycle services said, “I know I’m supposed to be shaking everybody down, but we’re not right now. My greatest fear is for patients who are already suffering from the COVID virus or issues after or have lost their job. I’m hesitant to also say, ‘Your insurance company has passed along this $50 copay.’”
The same question of who is to pay for antibody testing is also arising. The antibody test shows whether someone was previously infected and possibly immune, which is becoming an increasingly important condition to know as states reopen. Jeffries & Co, a Wall Street firm, estimates that the hundred of millions of antibody tests in the next 18 months will account for 25% of an anticipated $15 billion in COVID-19 testing through the end of 2021
According to Reuters, insurers argue that employers or the government should pay this nearly $4 billion bill. Insurers seem to be marking a divide between medically necessary tests and those done for research or return-to-work purposes. Providers, however, see antibody testing as an important part of understanding COVID-19 and the protection prior infection provides.
Andrew Matta, who leads the North American Dental Group, says the uncertainty around coverage of tests for non-medically necessary purposes is slowing a return to business.
Health policy professor Sabrina Corlette of Georgetown University says there should be a separate government-run fund for testing to make sure all patients, regardless of whether they are insured, can get the antibody tests. Without this protection, she says the risk of coronavirus will abound in society.