- After receiving a surprise medical bill for a COVID-19 test, Rep. Katie Porter, D-Calif., is calling on the Trump administration to provide "formal, explicit" guidance — and enforcement consequences — for health insurers to make sure patients aren't dinged financially for diagnostic testing.
- Coronavirus relief legislation included provisions mandating insurers cover COVID-19 tests without cost-sharing, yet patients across the country are still receiving bills: an illegal practice, Porter said in a letter to key administration health officials sent Monday and shared with Healthcare Dive.
- The letter comes after Porter said she received a bill after getting a COVID-19 diagnostic test on March 23, which put her on the hook for $56.60 along with the $20 co-pay she'd previously paid, Axios reported. Porter's insurer, commercial giant UnitedHealth Group, told Healthcare Dive it couldn't comment on Porter's unique case without her permission due to privacy laws, but hypothesized her provider may have used the wrong billing code for her visit.
Widespread COVID-19 testing is critical for a data-driven pandemic response, especially as every state is in some phase of reopening despite cases increasing in pockets of the South and West. But five months into the pandemic emergency, the Trump administration has left testing strategies largely up to the states and has been vague on which players should cover testing under different circumstances.
Consumers are reporting a rash of expensive testing and treatment bills from the novel disease, and some providers are racking up thousands of dollars in unpaid testing costs without backup from insurers.
"Like many others in California and across the country, I was shocked to receive a bill for the doctor's visit and testing," Porter wrote to Centers for Disease Control and Prevention chief Robert Redfield, HHS Secretary Alex Azar and CMS head Seema Verma on Monday. "It is simply outrageous and unacceptable for the administration to promise that patients will not bear the brunt of coronavirus testing and then fail to take the actions necessary to fulfill that promise."
UnitedHealth told Healthcare Dive it has waived member cost-sharing since the onset of the pandemic, but some beneficiaries received bills early on, when there weren't yet specific COVID-19 billing codes. The payer is currently retroactively evaluating claims since early February to make sure cost-sharing was waived for COVID-19 cases.
But Porter wants HHS to issue explicit guidance and enforcement consequences for states, payers, providers, and testing companies to ensure patients don't get put on the hook for COVID-19 bills, in line with congressional coronavirus legislation passed late March.
The Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security Act required insurers cover the cost of testing without deductibles or co-pays, along with benchmarking funds for testing of America's nearly 28 million uninsured.
But patients have slipped through loopholes in the laws.
CARES explicitly requires commercial payers cover any fees associated with getting a test in an emergency room, urgent care center or doctor's office without cost-sharing, but only if a provider determines the test "medically necessary," which excludes precautionary testing for asymptomatic individuals.
Additionally, the law may not apply to self-funded employers, depending on one's interpretation of whether the legislation applies to health plans offered by employers which use their own money to pay claims to drive down costs. Those plans, which cover a majority of Americans, are not always waiving copays and other bills.
And, if a patient sees an out-of-network provider, they could still receive a balance bill for COVID-19 testing.
Redfield told the House Committee on Oversight and Reform on March 12 the administration was committed to making COVID-19 testing free for every American.
But patients are having to jump through hoops, which could hamstring widespread testing efforts. Only about 23.5 million tests have been conducted to date, according to the COVID Tracking Project — roughly 7% of the U.S. population, assuming one test equals one person.
Though hospitals, patient advocates and politicians have called on payers to do more, payer lobby America's Health Insurance Plans has maintained the sector is doing enough through steps like waiving cost-sharing for COVID-19 treatment, bolstering virtual care reimbursement and rolling back prior authorization requirements.
Widespread diagnostic testing for the illness could cost up to $25.1 billion annually, according to AHIP.