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Americans are getting hit with unexpected bills for Covid-19 tests and hospital visits, and regulators say the problem often lies with how doctors are billing.
Insurers and the federal government promised to make Covid-19 tests and services free to those with health insurance, but researchers say gaps remain. Federal rules only cover health services explicitly billed for Covid-19 that are deemed necessary by a doctor. Those who seek a test without a good enough reason could be left paying.
“You need that individualized determination by a licensed health professional that the test is medically appropriate,” Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University, said.
Lawmakers and public health officials say Covid-19 tests and treatment must be free and widespread to get the pandemic under control. Congressional leaders concerned about unexpected medical bills have focused on the role of the insurance industry—which has reaped record profits during the pandemic—instead of on health-care providers.
The federal government may be adding to the confusion around testing. Recent Centers for Disease Control and Prevention guidance indicates tests may not be needed for asymptomatic individuals and those who attended large gatherings but lack symptoms.
Public health groups warn the guidance leaves too much of the onus for testing people who might not have symptoms on local health departments or health-care providers, resulting in inconsistent testing rules across the country.
“We need to be clear and consistent,” leaders of the Big Cities Health Coalition and National Association of County and City Health Officials wrote in a letter to the CDC and Health and Human Services Department. “The new guidance is neither of those things.”
Some state insurance departments have been grappling with complaints from people who received surprise medical bills from Covid-19 tests or treatment they expected their insurance to cover.
Sometimes the problem is simply a coding mistake, regulators say.
One person in Kansas got a Covid-19 test and received a bill for $112.60 because the hospital coded the service as unrelated to Covid-19, according a complaint filed with the state insurance department in August.
A review of insurance records from more than two dozen state insurance departments show people have gotten bills ranging from about $100 to more than $3,500 from emergency departments and clinics for Covid-19 treatments or tests even after insurers paid their share.
Many complainants sought treatment they believed would be free.
One Connecticut resident complained about receiving a $573 bill for a test at a drive-through facility despite “endless” correspondence from the individual’s insurer, Anthem Blue Cross Blue Shield of North Haven, Conn., about Covid-19 tests being covered.
The insurer responded that Covid-19 tests are covered but the health-care provider also billed for a laboratory test that’s not appropriate for Covid-19 testing, meaning it would include some cost sharing.
Half of U.S. adults fear a major health event could lead to bankruptcy, and about a quarter say they would need to borrow money to pay a medical bill of $500 or more, according to a Gallup poll released Tuesday. About 14% of Americans would avoid care if they had symptoms of Covid-19 because of the potential cost, Gallup found.
Working With Insurers
Some states have contacted insurers and health-care providers to ask them to code Covid-19 tests and services to ensure they’re paid fully by insurers.
North Carolina’s insurance department received three complaints about surprise bills early in 2020, and in each case insurers just asked providers to resubmit their bills with the Covid-19-related codes so they would be fully covered, Barry Smith, a spokesman for North Carolina’s insurance department, said.
Nearly anyone who gets a Covid-19 test is coded as potentially exposed to the virus and therefore the service is free of any cost sharing for those with insurance, Kristine Grow, a spokeswoman for America’s Health Insurance Plans, said.
Twelve state insurance departments—Alabama, Delaware, Idaho, Indiana, Kentucky, Louisiana, Maine, Missouri, Nebraska, North Dakota, Oklahoma, and Vermont—said they haven’t received any complaints about surprise bills for Covid-19 tests or services.
Insurers aren’t required to pick up the full tab for routine testing or if someone simply wants to get tested as a precaution, Corlette said.
Big bills for testing may become less common as low-cost tests become more widely available. The federal government has agreed to purchase 150 million Covid-19 tests from Abbott Laboratories that cost about $5 each with the intention of giving them to high-risk populations, such as nursing home workers.
Legislation on Hold
AHIP told lawmakers this summer that the scale of testing needed to take on public health projects like contact tracing or routine testing of people who work in high-risk areas is too great for employers or insurers to cover. The group urged Congress to create a pool of funds to support such testing.
A group of lawmakers has been pushing to advance a surprise medical billing package through Congress since last year, but has been held up largely over opposition from Rep. Richard Neal (D-Mass.), chairman of the Ways and Means Committee.
The Republican and Democratic heads of the Senate Health, Education, Labor and Pensions Committee and the House Energy and Commerce Committee have advocated for legislation that ends balance billing, a practice where providers send bills to patients for costs their insurers won’t cover, which Neal opposes over its provisions dictating what providers can charge for certain services.
To contact the reporter on this story: Alex Ruoff in Washington at firstname.lastname@example.org