Three states now require insurers to limit out-of-pocket costs related to coronavirus testing, and more may soon jump on board. Tests administered by the Centers for Disease Control and Prevention (CDC) for COVID-19, the disease caused by a new virus called SARS-CoV-2, are free. But many patients still face bills from related doctor’s appointments and hospital visits.
In Florida, a patient reported a staggering $3,270 bill after getting tested to see if he had COVID-19. A blood test confirmed he just had the flu, but then he was stuck with the bill; his catastrophic insurance plan refused to cover the balance, according to the Miami Herald.
Aaron Katz, a principal lecturer for the University of Washington’s School of Public Health, said the recent rash of cases has highlighted the cracks in the U.S. health system where many patients slip through.
“It’s important to remember that these costs were always being faced by people, especially by lower-income people, people with no insurance or with very skimpy insurance,” he said. “This epidemic is highlighting those barriers. Now we really see, oh, this isn’t just an individual thing. Whether I take care of myself has an effect on you.”
Testing costs covered
With the number of reported cases growing daily, New York, California and Washington state have taken emergency measures to reduce cost barriers to testing.
On Thursday, Washington’s Insurance Commissioner issued an emergency order requiring all health plans — including short-term plans — to cover the cost of health care visits related to testing for COVID-19. That includes the cost of the visit as well as testing.
There’s still a catch: the insurance commissioner’s office recommends patients call their doctor’s office ahead of time to make sure they have the symptoms associated with COVID-19. Otherwise, they could be on the hook for their copay or deductible.
Washington is also requiring insurers to allow patients a one-time refill of their prescriptions.
In New York, the state’s Department of Financial Services began requiring insurers to waive costs associated with testing, including emergency room, urgent care and office visits, starting last week. On top of that, the state will also require them to cover the cost of a COVID-19 vaccine, if one becomes available, and is urging insurers to develop telehealth programs to offset pressure on hospitals.
In an emailed statement, the New York Department of Financial Services said insurers were cooperative, working with the agency to ensure there are no barriers to testing.
“New York State has been taking steps to prepare our health-care system and ensure our residents are protected and know the facts,” Financial Services Superintendent Linda A. Lacewell said in a news release. “Insurers need to do all they can to support consumers and the public health as we take action to address coronavirus. Removing barriers to testing will strengthen the system for everyone and potentially keep overall costs down as people get the help they need.”
California, which reported new cases across the state, also implemented similar measures on Thursday to limit out-of-pocket costs for testing.
More states may join
“I expect a number of other states to take proactive action,” Katz said. “If someone gets hospitalized, those costs begin to escalate really, really fast. There are other costs that aren’t really healthcare costs — The cost of missing a day of work, transportation costs to get to a facility, the cost of daycare or babysitters for kids while you go get treatment.”
The U.S. has a total of 221 confirmed or suspected cases, according to data compiled by Johns Hopkins University. That includes more than 50 cases in Washington state, and 20 in New York, as of Thursday evening.
Most people who have contracted the virus had mild symptoms, but about 14% experienced severe disease and 6% became critically ill, according to the World Health Organization. A total of 12 deaths in the U.S. have been attributed to COVID-19, including 11 in Washington and one in northern California.
Unfortunately, measures taken by these states don’t help one large group of patients: the uninsured. Federally qualified community health centers are required to treat people regardless of their ability to pay, but many people don’t know that.
“I can imagine that they would be worried if they have symptoms, if I have to go in for treatment, am I going to have to pay for that?” Katz said. “We live in a healthcare system in which money matters, and having an insurance card is one key into the system.”
Insurers are also beginning to address the cost of testing. On Thursday, Cigna said it would cover the cost of FDA-approved testing related to COVID-19, falling into line with recommendations from America’s Health Insurance Plans (AHIP). The insurance trade group issued a statement that its members — which include Cigna and Humana — would cover testing when ordered a physician. AHIP also said its members would ease prior authorization requirements, waive patient cost-sharing, and encourage the use of telehealth.
Experts expect the number of reported cases to increase as more patients gain access to testing. Up until this week, testing was limited to symptomatic people that had traveled to one of a few countries recently affected by COVID-19. Now, the CDC has lifted restrictions on testing, Vice President Mike Pence said on Wednesday. An initial batch of faulty tests delayed testing availability, but Pence said the CDC would distribute 2,500 test kits around the country this week.
A number of private companies are also developing their own tests, which would face an expedited review from the Food and Drug Administration. Quest Diagnostics said that it would begin offering testing on March 9, though its test hasn’t yet been approved. The company also has not specified how much its tests will cost.
Photo credit: Centers for Disease Control and Prevention (CDC)