Free Coronavirus Testing for Privately Insured Patients?
Karen Pollitz Apr 20, 2020
With enactment of the Families First Act and the CARES Act, privately insured people in the US are eligible to have the cost of coronavirus testing covered 100% by their health plan. Free testing is a key public health strategy; removing cost barriers will make it easier for people to get tested once testing capacity increases. However, the new federal requirements do not necessarily mean that insured patients won’t be asked to pay up front for the cost of testing, or that they can easily be reimbursed.
The Families First Act, effective March 18, required private health plans to cover coronavirus testing and related visits with no cost sharing. The CARES Act, effective March 27, amended this to require private plans to fully cover the cost of out-of-network testing, as well. Private plans must provide full coverage for diagnostic tests and antibody tests. However, federal law does not prohibit coronavirus test providers from billing patients directly, nor does it limit what can be charged for the test. Providers are only required to post their cash price for the test on a public web site. Insurers can negotiate a discounted fee with out-of-network test providers, otherwise they should pay the posted cash price.
Out-of-pocket costs charged for coronavirus tests
The table below shows examples of some coronavirus test providers in high impact states, with links to their web sites and, in some cases, to other price information reported in the press. These examples were selected from an unsystematic web search and may not represent test site practices generally. Some of the providers shown below have posted test price information online. Some note what insurance they accept and whether they will bill insurers directly. In these examples, posted test prices range from $59 to $229. Other providers do not appear to have posted any price information online. Several providers test all patients for free. According to one news story, in some areas testing is more widely available for patients who can afford private testing, while free public testing may be more limited.
|Examples of Price Information for COVID-19 Test Providers|
|Poughkeepsie, NY||Northern Medical Group||$176||Will bill insurance directly, $51 for test and $125 for virtual visit for uninsured|
|Utica, NY||Mowhawk Valley Health System Drive Thru||Free|
|Passaic, NJ||William Patterson University||$59||“Some insurances may cover this fee”|
|Essex County, NJ||The Doctors’ Office Urgent Care||None found|
|Waltham, MA||AFC Urgent Care||$199||Price listed for patients without insurance|
|Detroit, MI||Beaumont Hospital||TBD||No payment collected initially, cost to be billed later, if any, determined by availability of other resources|
|Philadelphia, PA||Penn Medicine||No charge||No deductibles or copays for insured; uninsured tested for free|
|San Jose, CA||Red Dot Fitness||None found||Press reports $225 price for antibody test|
|Chicago, IL||Midwest Express Clinics||None found|
|Hialeah, FL||Larkin Community Hospital||$150||Does not accept Medicare, Medicaid or private insurance|
|New Orleans, LA||West Jefferson Medical Center||None found|
|Hammond, LA||Post Acute Medical Specialty Hospital||$169||Medicare accepted. Other insurance may reimburse you|
|Dallas, TX||Sinai Urgent Care||$229||No payment collected from insured patients; cash price for uninsured|
|Houston, TX||My Family Doctor Clinic||$150||Press reports free to patients with insurance|
|Washington DC||All Care Clinics||$125||No charge if participates in patient’s health plan|
|South Dakota||Sanford Health System||Free|
If insured patients get tested by an out-of-network provider, they must submit a claim to their health plan for reimbursement. That can take some doing, as these examples of out-of-network claim forms by major insurers show. Required information includes the billing provider’s National Provider Identify (NPI) number and taxpayer ID number, the CPT or HCPCS billing code for the claim, and the ICD-10 diagnosis code. It is unknown how many patients may find this too complicated, and never submit a claim for reimbursement – something claims experts call the “shoebox effect.”
It is also not clear whether or how much of the cost of COVID-19 testing private plans may reimburse if out-of-network providers don’t give needed billing information to patients, or if they have not publicly posted their cash price.
Different proposals for ways to come out of this pandemic have in common increased testing – testing far more people than we do today and testing them repeatedly. Testing capacity will need to be built well beyond what there is today, but once built, out-of-pocket cost considerations may affect whether patients will come.