You’re not supposed to get a bill for coronavirus tests. But as anyone who’s ever gotten a surprise medical bill can tell you, just because you’re not expecting to be charged doesn’t mean you won’t be.
So what can you do to make sure you’re not stuck holding the tab?
First, keep in mind that testing and care relating to diagnosing the coronavirus is covered by recent legislation. The Families First Coronavirus Response Act provides that all COVID-19 testing be covered by either the patient’s insurer or the government. The CARES Act expands on that and requires that health plans reimburse providers for related services, even if they’re out of the patient’s plan network.
So don’t avoid getting medical care if you’re worried about costs, advised Caitlin Donovan, a spokesperson for the nonprofit Patient Advocate Foundation.
And if you do get a bill for your care, she has tips on how to handle it.
Medical billing errors are common
You may have seen some examples of worst-case scenarios that have left patients holding the bill for their coronavirus-adjacent care:
CNET spoke to a Colorado woman who said her insurance covered her coronavirus test, but not any of the costs relating to the accompanying trip to the emergency room her symptoms required.
In another case reported by NPR, a West Virginia woman’s doctor tested her for other ailments to rule out other possibilities due to the shortage of COVID-19 tests. When she tested positive for influenza B, she ended up with a $500 bill after insurance.
That situation isn’t uncommon, according to NPR. Some medical providers may have to rule out other illnesses before ordering a COVID-19 test, potentially leaving patients on the hook for costs related to other tests or office visits.
That means it’s up to you to verify any costs prior to being seen by a health professional—which sounds like a nightmare when you’re not feeling well, right?
Do your research before seeking care
The first way to avoid charges is to make sure you’re following directions. That means looking up restrictions for testing centers (some may require an order from a physician) once you find what’s available near you.
If you have insurance, the best time to find out what’s covered is before you’re sick—but with high demand and long wait times by phone, we’re going to guess you haven’t done that.
If you don’t feel well, check your insurance carrier’s website first—Donovan said most have special coronavirus information pages. Taking a screenshot of those pages or printing them can help you if you need to file an appeal later on.
If you need help getting information (remember, we’re assuming you feel like crap by this point), you can enlist a friend or family member to help you. Health privacy rules specify that a health insurance carrier can provide plan information to someone who’s calling on your behalf.
Donovan recommends calling your insurer first, with your family or primary care doctor second, before directing any questions to a large health facility in order to get the most helpful information.
Don’t rush to pay any bills
If you’re being tested for the coronavirus, you shouldn’t have to pay a copay or coinsurance, Donovan said. But if you get a bill after your visit, don’t pay right away, she advised.
Instead, wait until your explanation of benefits (EOB) comes by mail or electronically. Once you receive that statement, you’ll know your insurance carrier has processed your claim and you can compare it to your billing statement. “It should match up,” Donovan said. “If not, there’s been a mistake.” She explained that a lot of medical bills have errors, and with details of coronavirus care changing so quickly, you should expect errors on any post-care bills you receive.
Use the appeals process as a last resort
That doesn’t mean you won’t have to pay anything for your care. If you get tested for strep or flu, you may get billed for those tests. If you end up having the coronavirus and need care, you may need to come out of pocket for some of those costs.
But you should be able to easily make the case for your diagnosis-related care to be covered. “If your bill has been processed by insurance and you’re still getting a bill, call your insurer first. If the insurer says you shouldn’t be getting billed, call the provider,” Donovan said. The Patient Advocate Foundation offers a guide to the appeals process, if you end up needing to appeal a denied insurance claim.