Health data firm Castlight found that insurers are holding patients responsible for about 2.4% of coronavirus claims, according to a recent New York Times article.
Since April, Americans have been repeatedly assured by the president and Congress that coronavirus testing would be widely available and free. So why are so many finding themselves stuck with the bill?
Early on in the pandemic, Congress acknowledged guidance from medical experts that testing was crucial to tracking and slowing the spread of the virus. But as the pandemic gained steam and cratered the economy, the number of Americans losing jobs—and with it, medical insurance—skyrocketed.
“It is critical that Americans have peace of mind knowing that cost won’t be a barrier to testing during this national public health emergency,” Medicare administrator Seema Verma told the New York Times in April.
But President Donald Trump faced a political dilemma. Major insurance companies and medical industry experts were pressuring the administration to greenlight a special open enrollment period for Affordable Care Act marketplaces, to cover the individuals who would otherwise go without insurance. However, Trump and his associates were already embroiled in a legal campaign to dismantle the healthcare law that expanded coverage to more than 20 million people.
Instead, once Congress passed two federal coronavirus relief packages that included laws requiring insurers to pay for tests, Trump hastily created his own program to cover COVID-19 testing and treatment for uninsured people, using money from the legislation.
“This should alleviate any concern uninsured Americans may have about seeking the coronavirus treatment,” Trump said at the time.
The Families First Coronavirus Response Act, passed in March, said insurers could not charge co-payments or apply deductibles to coronavirus tests. And May’s CARES Act made insurers cover out-of-network coronavirus tests at no cost to the patient. Cities and states set up free testing sites and people began streaming in. But a recent special investigation by the New York Times found that patients nationwide are receiving unexpected and sometimes astronomical bills.
Health data firm Castlight found that insurers are holding patients responsible for about 2.4% of coronavirus claims. With more than 84 million tests performed so far, hundreds of thousands of Americans, insured or not, are receiving unexpected bills ranging from a few dollars into the tens of thousands.
“Whether it’s through legislative action or public statements, Congress has made it really clear that there shouldn’t be cost sharing for COVID-19 testing,” said Julie Khani, president of the American Clinical Laboratory Association. “In practice, that’s not really the case.”
Calls to insurers revealed practices such as disqualifying patients whose primary diagnosis was not COVID-19, but may have exhibited symptoms and were therefore tested, from the no-cost clause. Some insurers have applied co-payments and deductibles to the tests, or covered the test but denied payment for doctor’s visits or other services that accompanied it.
In a recent ProPublica/Texas Tribune investigation, one family shared their itemized health insurance statement, where they discovered the total cost of a drive-thru COVID test for their son came out to $2,479: $175 for the test, $1,784 for a facility fee, and $486 for the physician fee.
Insurers appear to be reading between the legal lines for interpretations that favor the companies and sometimes outright violating federal laws. They also blame U.S. medical billing practices, and say doctors and hospitals are coding forms incorrectly.
“This is not the way you deal with uninsured people during a public health emergency,” Sara Rosenbaum, a professor of health law and policy at George Washington University, told the New York Times.
More testing continues to be a necessity in combating the pandemic. A study published in Nature Journal found that the total number of coronavirus cases in the U.S. up to April 18 was likely three to 20 times higher than reported, due to the limited number of available tests being restricted to patients exhibiting symptoms. “Confirmed COVID-19 case counts in the U.S. do not capture the total burden of the pandemic,” researchers at the University of California Berkeley wrote.
The Centers for Disease Control and Prevention has made similar statements indicating the country’s cases are much higher than official tallies. In June, CDC Director Dr. Robert Redfield said testing likely missed 90% of infections.The US should be performing about 200 million COVID-19 tests a month heading into 2021, to stand a chance at controlling the pandemic, according to a new report released by the Rockefeller Foundation and the Duke-Margolis Center for Health Policy Wednesday. Currently, less than 30 million tests are conducted on a monthly basis.