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What To Do If You're Billed For a COVID-19 Test

Young Hispanic woman looking at bills.

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Key Takeaways

  • While a COVID-19 test should be covered under the CARES Act, there are other charges that some facilities or providers can tack on that will not be covered, meaning you'll get stuck with a bill.
  • There are many factors that can affect coverage, and it's up to you to sort them out. If you get a bill you disagree with, it's worth calling the facility to try to negotiate.
  • You can avoid a surprise bill by asking your insurance provider what's covered and making sure that you know which medical billing code your provider uses to order the test.

One of the most crucial aspects of controlling the COVID-19 pandemic has and will continue to be testing. The passage of the Coronavirus Aid, Relief, and Economic Security Act (CARES) addressed one of the biggest worries people have about testing—how they will pay for it.

For most people, COVID-19 testing should be paid for as provided under the provisions for testing and preventative care. However, as some people are finding out, there are other things that can be charged for other than testing supplies and lab fees.

It's important to get tested for COVID-19, but you also want to understand why you might get a surprise bill, and what you can do to avoid it. Here are a few factors that can affect whether your COVID-19 test is covered.

A Real-World Example

In July, Ellen Dacareau, a communications consultant in Austin, Texas, was hit with a surprise bill from a freestanding ER where her 6-year-old daughter had gotten a COVID-19 test.

At the time, testing supplies were scarce. Dacareau called around to different facilities, including through the city of Austin, and found that she wouldn't be able to get her daughter tested for a week or longer.

She sent her husband to a standalone ER with instructions to pay out of pocket for a test rather than billing insurance because she had heard about unexpected bills being an issue. However, the facility refused to take an out of pocket payment and ran the insurance anyway.

Six or seven weeks later, Dacareau received a bill for roughly $4,000. Shocked, she called the facility to investigate.

"I know what a coronavirus test looks like—it's a swab up the nose, they put it in a baggie and send it off for testing. A physician never touched my daughter," Dacareau tells Verywell. "The billing person said, 'We aren't going to charge you for anything outside of what your health insurance is going to cover."

By calling to investigate the bill she received, Dacareau found that her insurance covered roughly $1,400. The facility wrote off the rest of the stated cost, saying that they forgave it because of the community need for COVID-19 tests.

How Facilities Can Charge More

Molly Moore, chief health plan officer of health insurance start-up, Decent, tells Verywell that some medical facilities are using loopholes in the CARES Act to add extra charges.

Facilities are required to offer the test for free—meaning the testing supplies and lab expenses to process the results—but there are other things that are not covered.

"The CARES Act says that they can charge for 'PPE' at the time of collection. The government has essentially said that facilities can charge for this, and they will pay for it," Moore says. "But in the views of expediency, they didn't cap it at a reasonable amount."

An open charge line can lead to what Moore calls "egregious" charges to recoup lost income from things like canceled elective surgeries. Those charges and others, like the facility fees specific to the location in which you are tested, can produce astronomical bills for a relatively low-cost test.

Insured vs. Uninsured

Allison Madden, assistant vice president for performance improvement at Community Health of South Florida, tells Verywell that for the uninsured, seeking public health options is the best bet.

With the cost of testing covered by The Department of Health and Human Services (HHS) via reimbursement, public health departments lack the additional specialized fees that can come with hospitals and private clinics.

"If you have insurance, we do bill insurance, and the insurance covers the cost of the testing," Madden says. "For the uninsured, HHS is supposed to cover the costs of those tests. Reimbursement of the test is based on the CPT code (a code assigned to every medical procedure or task). There needs to be a valid medical diagnosis such as symptoms or exposure."

Medical Necessity

Madden adds that another factor in testing costs is whether the test is a medical necessity. Typically, if a patient has symptoms of COVID-19, such as cough, difficulty breathing, or body aches, a test would be covered.

However, if they were being tested for a wide range of viruses (such as the flu) or received the test during a routine appointment, the coding would be different—which, in turn, could trigger additional costs.

Public health departments have been hosting pop-up testing sites since the start of the pandemic. Government websites should offer access to free testing sites in the area, which is a good bet if you want to be sure of the cost beforehand.

How to Make Sure Your Test Is Covered

For COVID testing, the onus is on the patient to ensure they are covered. Alexa Banculli, clinical operations manager at Eden Health, tells Verywell that the most effective way to ensure that you'll be covered is to arm yourself with the information upfront.

Ask About What's Covered

"The first step is determining your plan's current coverage for the specific test(s) you want," Banculli says. "You can ask your insurance plan questions: What is my coverage for COVID testing? Do you cover rapid tests, PCR tests, and antibody tests? Do you cover these whether they are done with an in-network or an out of network provider or laboratory? Do you cover at-home testing kits that are not ordered by a medical professional?"

If your plan says that it will cover tests at 100%, then there should be no cost to you to get it. To ensure that your healthcare provider orders the test correctly, ask them which code they are using.

Medical Coding for Beginners

Coding drives modern medical billing, including COVID-19 testing. If you're not a medical professional, knowing the billing codes can seem like a herculean task but there are websites out there that can help. FindACode.com offers an entire section on COVID-19 codes that help you know what to ask for when searching for the right test at the right price--free.

Ask for an EOB

Licensed health insurance agent Christian Worstell tells Verywell that many patients are alarmed at seeing an Explanation of Benefits (EOB) from their health insurance company because it can be mistaken for a bill.

However, EOBs list the costs of services provided and reflect what has been negotiated down or covered by your insurance plan. If an actual bill is sent with charges that you disagree with, the first step is to appeal to your health insurance company.

As Dacareau found out when she received a $4,000 bill for her daughter's test, sometimes questioning the provider's charges can lead to charges being dropped or lowered.

What This Means For You

COVID-19 testing itself is covered under the CARES Act, but there are many nuances to billing that can be manipulated by healthcare providers.

To avoid fees, make sure that you know what you're being charged for beforehand, understand healthcare billing codes, and check that nothing else is piggybacked on your testing appointment.

If you're uninsured, contact your state or local government to find a free testing site near you.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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  1. Text - S.3548 - 116th Congress (2019-2020). CARES Act. Updated June 03, 2020.