Have you been billed for COVID-19 tests or treatment? You may be due a reimbursement

·6 min read

Dec. 14—The government and health insurers made moves early in the pandemic to limit out-of-pocket costs to obtain COVID-19 services — such as testing and treatment — during the public health crisis.

Though many opportunities for free services still exist, many others have been scaled back, and patients all along have ended up being billed due to loopholes, lack of oversight, confusion and administrative red tape.

Access Family Pharmacy in Hixson is one local provider offering an array of COVID-19 services, including multiple options for rapid testing, vaccines and monoclonal antibody treatment.

Vaccines are always free, but pharmacist Phil Smith said billing for other coronavirus-related care is "all over the place" depending on the service, provider and the patient's insurance coverage. He recommends that patients don't assume COVID-19 services are covered and to call their insurance companies before seeking care to avoid getting unexpected bills.

"We tell people to call all the time just to make sure. And a lot of times, insurance companies are good at telling you where to go to get it covered 100%. A lot of people are just scared to call their insurance company," Smith said. "Get the name of who you talk to in case you get the wrong information."

(COVID-19 charges: Have you had questionable charges? Tell us about it at timesfreepress.com/covid-costs)

Vaccination

For now, patients pay nothing for COVID-19 vaccines regardless of whether they have insurance. Depending on the provider, they may bill insurance to recover their cost of administering the shots — such as staffing and handling — but patients should not owe money related to vaccination.

A federal program is available to reimburse providers for COVID-19 vaccine administration to people without health insurance.

Patients who receive a bill for a COVID-19 vaccine are encouraged to report it to the U.S. Health and Human Services Office of Inspector General Hotline at 800-HHS-TIPS or by filing a complaint online.

Treatment

Early in the pandemic, many health insurers said their members wouldn't face out-of-pocket charges for COVID-19 treatment, but most private insurers have either reimplemented cost-sharing for treatment or are expected to do so in the near future, according to an analysis from the Peterson Center on Healthcare and the Kaiser Family Foundation published in August.

Health insurance companies were never required to waive treatment costs for patients but many did so anyway, likely because insurers saw large profits throughout much of 2020 as Americans sought fewer health care services in general, the analysis found.

BlueCross BlueShield of Tennessee spokesperson Alison Sexter said in an email that the company returned to applying normal benefits to COVID-19 treatment once vaccines became widely available, "meaning members pay their normal plan cost share for any treatment."

Uninsured people should not pay for COVID-19 treatment because the U.S. Department of Health and Human Services provides claims reimbursement to health care providers — generally at Medicare rates — for treating uninsured individuals with a COVID-19 diagnosis. The program applies to hospital care as well, according to Erlanger Health System spokesperson Blaine Kelley.

"Uninsured patients presenting due to confirmed COVID are still fully covered at this time by the federal government for inpatient care," Kelley said in an email.

Testing

Federal law says patients should not have to pay out of pocket by sharing the costs for "medically-appropriate" COVID-19 testing or related services with their insurer.

However, providers may still bill insurance in order to be reimbursed for the cost of those services, and each company can interpret the rules differently and leave patients with unexpected charges, according to the Vanderbilt University Medical Center website.

For example, UnitedHealthcare's website states medically-appropriate COVID-19 tests must be FDA-authorized or approved and be ordered or reviewed by a health care professional to either diagnose the disease in a person showing symptoms or who was potentially exposed or to facilitate treatment.

"UnitedHealthcare health plans generally do not cover COVID-19 surveillance testing, which is testing used for public health or social purposes such as employment (return to workplace), education, travel or entertainment," the website states.

But guidance from the federal Centers for Medicare and Medicaid Services states insurance companies cannot impose those types of screening criteria on COVID-19 test coverage.

"When an individual seeks and receives a COVID-19 diagnostic test from a licensed or authorized health care provider, or when a licensed or authorized health care provider refers an individual for a COVID-19 diagnostic test, plans and issuers generally must assume that the test reflects an 'individualized clinical assessment' and the test should be covered," according to a list of frequently asked questions and answers from the Centers for Medicare and Medicaid Services.

Similar to treatment, uninsured people should not be billed for COVID-19 testing, which is reimbursed through the federal government.

Even when the test itself is fully covered, patients may still owe for the visit and any other services they receive, such as additional tests or clinical evaluations.

The same is true for hospitalized patients, Erlanger spokesperson Blaine Kelley said.

"Patients are billed for room and board, tests and any applicable procedures and care," Kelley said in an email, adding that coverage depends on the insurer and plan, and patients can tell based on their explanation of benefits.

The Kaiser Family Foundation also notes that the law does not prohibit out-of-network providers from balance billing for COVID-19 tests and related services.

"Instead, the law requires providers to publicly post their cash charges for testing and related services and requires insurers to reimburse the providers at their cash price if posted, but the law is silent on what insurers must pay for COVID-19 tests and related services rendered by out-of-network providers if no cash price has been posted," according to Kaiser.

Pharmacist Smith said Access does not take insurance for testing services. That's because COVID-19 testing is covered under a patient's medical insurance benefit rather than their pharmacy benefit, and it would take extra administrative work for Access to enroll in medical benefit plans.

However, patients can submit documentation of the services they receive at Access — or any other pharmacy or clinic without medical benefit coverage — to their insurance company in order to get reimbursed.

"We have a lot of people doing that," Smith said.

Insurance companies are far less likely to reimburse over-the-counter COVID-19 tests that can be purchased at retail stores and taken at home, but the Biden administration is moving to require them to do so in the new year.

"The Departments of Health and Human Services, Labor and the Treasury will issue guidance by Jan. 15 to clarify that individuals who purchase [over-the-counter] COVID-19 diagnostic tests will be able to seek reimbursement from their group health plan or health insurance issuer and have insurance cover the cost during the public health emergency," said a Dec. 2 statement from the White House.

Critics of the plan said requiring Americans to buy the tests, which typically cost around $25, and submit reimbursement claims is still a major barrier to expanding access to affordable and convenient testing.

COVID-19 charges

Were you or someone you know confused or surprised after receiving a medical bill related to COVID-19? The Times Free Press is looking for examples of improper or exorbitant charges for COVID-19 services across the Chattanooga region to use in our ongoing coverage of the pandemic and would love to hear from you.

Contact Elizabeth Fite at efite@timesfreepress.com or follow her on Twitter @ecfite.

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