How To Avoid A Surprise Bill For a COVID Test?

How to avoid a surprise bill when receiving COVID-19 testing?

The CARES Act and Families First Coronavirus Relief Act are supposed to ensure free COVID-19 testing for everybody, including people without insurance. 

However, research indicates that this has not always been the case. There have been numerous instances where patients experienced high out-of-pocket fees ranging anywhere from a few hundred to a few thousand dollars for receiving COVID-19 testing. 

Castlight estimates that 2.4% of all coronavirus testing bills lump a share of the costs to consumers, which means there could be millions of patients facing fees they did not expect.

To understand what you might have to pay, see our analysis of coronavirus testing costs at the top urgent care in the United States.

When would my insurance NOT cover coronavirus testing for free?

Albeit federal and state governments made efforts to push insurers to guarantee no-cost testing, our independent research found thousands of surprise bills from individuals who got tested. Here are the top 3 reasons why people receive surprise bills after getting tested:

1. Have symptoms, but was not tested: individuals who have symptoms and suspect that it is COVID-19 related may seek care at a medical clinic. But if an approved coronavirus test was not ordered, the visit may be billed under a different diagnosis and therefore not covered by your insurance.
2. The test was not FDA authorized: there are many types of tests for different purposes with different sensitivity levels. According to United Health Group, the nation's largest insurer, "tests must be FDA-authorized to be covered without cost-sharing. FDA-authorized tests include tests approved for patient use through pre-market approval or emergency use pathways".
3. You got a bill from the lab: if you get tested at urgent care, chances are your sample will be sent to a lab for processing. The lab is a separate entity and will bill your insurance or you separately. Depending on your insurance policy, the doctor visit portion may be covered, but not necessarily the lab and vice versa.

4 Ways to Avoid Surprise Fees from COVID Testing 

To avoid these fees, it is important not only to advocate for yourself but also to understand the most cost-effective options when receiving testing. Outlined below are a few steps you can take to ensure that you pay the least amount out-of-pocket.  

1. One of the best options for avoiding surprise medical bills is a membership with Mira. For just $45/month, Mira members get access to affordable prescriptions, lab tests, and urgent care visits.
2. Most surprise medical bills related to COVID-19 testing do not arise from the cost of the test itself. Instead, these costs arise out of other services rendered by the provider that is not covered by the CARES Act. Before receiving a test, you should ask your provider what will appear on the bill to ensure that there are no surprise charges, such as a fee for simply seeking treatment.
3. The best chance of avoiding surprise out-of-pocket costs is to get tested at a public facility. Very few patients have reported surprise medical bills from those testing sites (although it is still a possibility). The best place to see where you can get tested publicly is through your local county or state’s department of public health website.
4. Avoid emergency rooms and hospitals if you have mild symptoms. The majority of patients who experience surprise costs seek testing at hospitals and free-standing emergency rooms, which bill patients just for receiving treatment. These fees can sometimes exceed 10x the cost of the COVID-19 test itself. However, if you are experiencing severe symptoms or have an emergency, you should seek care at a hospital.