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Have Your Patients Been Charged with Surprise Bills for COVID-19 Testing?

No doubt, the Delta-variant is the driving force behind a new flood of nationwide testing that could translate into more surprise medical bills for those being tested.

The CARES Act and Families First Coronavirus Relief Act are supposed to ensure free COVID-19 testing for everyone, including those without insurance. But patients, both the uninsured and those with good coverage, are discovering holes in that coverage.

For example, federal law doesn’t compel insurers to include “routine” testing that a growing number of workplaces and schools are currently requiring. This will certainly increase with the President’s mandate for certain persons to be vaccinated or routinely tested.

In fact, research shows there have been numerous instances where patients have experienced high out-of-pocket fees ranging from a few hundred to a few thousand dollars for receiving COVID-19 testing.

So, What are Patients to Do?

If possible, patients should get tested at a public facility.

Most communities have public testing facilities where very few patients have described surprise medical bills. Patients are counseled to go to their state’s health department website for the locations of such testing.

No facility available nearby? Patients should consider their primary care physician or federal qualified health clinic. It’s been observed that the largest COVID-19 test bills come from hospitals and free-standing emergency centers. For example, a patient in New York faced a $1300 bill after being tested in a tent outside a hospital. The charge was typically deemed as a “facility fee.”

Patients Should Ask the Healthcare Provider for What They’re Being Billed

Most surprise medical bills related to COVID testing do not result from the cost of the test itself. Rather, these costs stem from other services by the provider that are not covered by the CARES Act. Before getting tested, the patient should ask the healthcare provider what will appear to on his/her bill to help ensure that there are no surprise charges, such as a fee for simply seeking treatment.

To avoid extra charges, simply ask your provider “I’m having a COVID-19 test. Are there any other charges I can expect?”

What if the Patient is Uninsured?

Patients without health insurance don’t have the same guarantee as those with coverage to receive free testing, although Congress did attempt to deal with this. Under the coronavirus relief laws, the government set up the Provider Relief Fund. Rather than billing the patient, hospitals and other healthcare providers who offer testing services to the uninsured can submit claims to the fund.,

But not all providers are cognizant of the fund, nor do they want to go through the annoying paperwork to apply for reimbursement. Says one observer, “It’s easier to bill the patient.” In that case, the patient needs to appeal the charge.

In addition, 17 states have authorized their state Medicaid plans to cover Covid-19 testing for those uninsured. Patients need to check if they reside in one of these states.

Patients Should Know Their Rights Under United States Federal Law

Federal regulations watch over how healthcare providers and insurers bill patients for COVID testing. Patients need to appreciate how these regulations affect them and will help to push back on unauthorized charges.

By and large, these laws assert that health insurers must cover the costs of COVID-19 tests ordered by a doctor. This means that standard deductibles and co-payments for other provider services do not apply.

As described above, there is one important exclusion: Insurers do not have to pay for routine testing required by a school or workplace. If, for example an employer requires that an employee get tested weekly, it’s up to the employee’s healthcare plan to determine whether or not they will pay.

So, again, a patient needs to be wary about where they get tested and ask questions concerning any fees. Some employers are now directing workers to get tested at a public site, in part to eliminate or reduce any surprise charges.

For the COVID-19 tests that insurers must cover, gray areas persist. The law specifies that they are obliged to cover any other services necessary to get the COVID-19 test but doesn’t explain precisely what.

Most authorities concur that a doctor’s visit fee is a clear-cut example of a service that should qualify and that patients facing these types of charges need to appeal them to their insurer.

Other services, such as an x-ray performed at the same time as the COVID test are somewhat cloudier. If a patient is billed for these type services, he/she needs to ask their physician to tell why such further care was necessary.

Are Medical Codes the Culprit?

One final item is what billing codes the patient’s healthcare provider applied for the test visit. Research has shown that a number of the surprise bills include providers who charge for a visit fee, then send the test to an outside laboratory that submits its own claim. 

The patient’s insurance plan might apply a co-pay to the healthcare provider visit because it’s not clearly linked in the billing records to the Covid-19 test.

In such cases, the patient might need to work with the provider to get the visit record to show that a COVID test actually took place.

What Medwave Can Do for You!

With our medical billing expertise, Medwave can eliminate the hassle of billing for COVID testingOur professionals are aware of the various pitfalls in the proper billing for COVID-19 testing and will assure that the correct entity will be held responsible for the test.

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