Out-of-network costs and 'surprise billing' could lead to unexpected charges
Here is what you need to know about getting tested for COVID-19.It’s supposed to be free. The new law mandates that Medicare, Medicaid, other government plans, and most private plans cover COVID-19 testing — and all testing-related services — entirely. That means no co-pays, no deductibles, no co-insurance charges.But beware. Our health care system is a mess and the law does not explicitly prohibit charging you if you go to an out-of-network provider.
The law requires insurers to cover testing and doctor’s office, urgent care, telehealth or emergency room visits as long as the services “relate to the furnishing or administration” of a COVID-19 test or “to the evaluation of such individual for purposes of determining the need” of a test.
“When your health plan has to cover [testing], that just means the health plan has to cover what it would say is a reasonable charge,” explains Karen Pollitz, a senior fellow at the nonpartisan Kaiser Family Foundation. “The difference between what your health plan thinks is reasonable and what the provider bills you, that’s on you.”
The law also only covers testing starting the day it was enacted, March 18. So if you got tested before then, this will not apply to those services.You should theoretically still be able to get tested for free. The March 18 law offers two solutions. The first is that it gives $1 billion to the National Disaster Medical System to reimburse medical providers for testing and diagnosing uninsured patients.
The other solution is that the law boosts funding for Medicaid and allows states to choose to cover uninsured residents’ testing for free through that program — meaning you would be temporarily enrolled in your state’s Medicaid program for the purposes of being tested.
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