Article written by Dr. Daliah.
When the COVID pandemic hit, Congress passed the Families First Coronavirus Response Act which required private health insurance, Medicare and Medicaid to cover COVID testing and related visits without price sharing to the patient. The summary of the text reads:
(SEC. 6001) THIS SECTION REQUIRES PRIVATE HEALTH INSURANCE TO COVER TESTING FOR COVID-19 WITHOUT IMPOSING COST-SHARING (E.G., DEDUCTIBLES, COINSURANCE, OR COPAYMENTS) FOR THE DURATION OF THE PUBLIC HEALTH EMERGENCY DECLARED ON JANUARY 31, 2020. THIS COVERAGE INCLUDES THE COST OF ADMINISTERING SUCH APPROVED TESTS AND RELATED VISITS TO HEALTH CARE PROVIDERS.
(SEC. 6002) THIS SECTION REQUIRES MEDICARE TO COVER, WITHOUT COST-SHARING, VISITS TO HEALTH CARE PROVIDERS THAT RELATE TO COVID-19 TESTING DURING THE PUBLIC HEALTH EMERGENCY.
(SEC. 6003) MEDICARE ADVANTAGE (MA) PLANS MUST ALSO COVER COVID-19 TESTING AND RELATED VISITS WITHOUT COST-SHARING DURING THE PUBLIC HEALTH EMERGENCY. MA PLANS ARE ALSO PROHIBITED FROM INSTITUTING PRIOR AUTHORIZATION OR OTHER UTILIZATION MANAGEMENT REQUIREMENTS WITH RESPECT TO COVERAGE OF SUCH SERVICES.
(SEC. 6004) ADDITIONALLY, COVID-19 TESTING AND RELATED VISITS MUST BE COVERED WITHOUT COST-SHARING UNDER THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) AND MEDICAID DURING THE PUBLIC HEALTH EMERGENCY.
STATE MEDICAID PROGRAMS MAY ALSO COVER COVID-19 TESTING AND RELATED VISITS FOR UNINSURED INDIVIDUALS DURING THIS PERIOD. THE SECTION APPLIES A 100% FEDERAL MEDICAL ASSISTANCE PERCENTAGE (FMAP) TO SUCH COVERAGE.
Providers are able to bill the insurance for reimbursement for these services so as to not bill the patient.
Those without insurance are also eligible to have COVID testing at no cost to them.
However, many patients have been reporting bills and are confused if COVID-19 testing is supposed to be “free.”
Here might be some reasons for the “surprise bills”…..
It’s an error
If your visit to a clinic for COVID testing only was told it would be of no charge and a bill came to your address, it could be an error and you should contact the clinic to verify the charges.
Non-COVID-19 related complaints were addressed
If you were having symptoms related to other ailments such as asthma, stomach upset, flu, rash, etc. and received evaluation and management (such as a breathing treatment, xray, steroid injection), the care the medical provider provided may be subject to charges.
You went to a facility where free testing was not offered
Although most providers have a pathway to get reimbursed if one cannot pay for a COVID test they don’t necessarily have to offer the visit or test for free. The law states the insurance company must reimburse the provider, but if the provider does not get paid by the insurance they may forward the costs onto the patient. These could be contested, and if the facility received funds from the CARES Act, they are not allowed to bill for COVID testing and care.
So how can you avoid surprise bills?
Firstly, if you don’t have symptoms and you strictly need COVID testing, you can go to a location that offers free testing. These can be found through the Department of Health and Human Services website here.
Secondly, if you do go to a medical clinic for evaluation and testing, ask what tests will be run and which tests you will be responsible for when it comes to payment.
Thirdly, if you do need to go to a clinic for testing and evaluation and treatment, ensure they are on your insurance plan or if you are uninsured, you can verify if they received funding from the CARES Act Provider Relief Fund, as it prohibits them from balance billing for COVID testing and treatment.