Maya Kaufman 
Associated Press
A Covid-19 testing site in Brooklyn run by NYC Health + Hospitals
Anil Sindhwani is on the brink of being sent to collections. That’s what CareCube, an urgent care provider, told him Aug. 15 when it notified him by email of an unpaid $125 medical bill. The charge related to a COVID-19 test he had gotten in January at CareCube’s Park Slope clinic and for which his insurance carrier had denied coverage, the email said.
Sindhwani was surprised. He had never had to pay for a COVID-19 test. When he visited CareCube, he said an employee had checked his insurance coverage through UnitedHealthcare and told him he should not be charged.
As the pandemic drones on, New Yorkers like Sindhwani are reporting surprise medical bills for hundreds of dollars for COVID-19 tests, despite state and federal regulations that require health plans to cover the tests and the accompanying medical visits to obtain them. The New York Attorney General’s Office confirmed it is looking into the general issue of COVID testing costs but declined to elaborate.
The federal government requires insurers to cover diagnostic COVID-19 testing and the related visit without a copay, a policy that includes patients who are asymptomatic and who have no known or suspected exposure to the virus, as well as point-of-care testing. Federal guidance issued in February said the policy applies anytime “the purpose of the testing is for individualized diagnosis or treatment of Covid-19.” Testing for public health surveillance and employment purposes is not subject to the requirement.
The state Department of Financial Services says insurers may not impose copayments, coinsurance and annual deductibles for in-network diagnostic COVID-19 testing and visits to diagnose COVID-19 at an in-network provider, such as an urgent care center.
Nonetheless, insurance companies that cover New Yorkers maintain a kaleidoscope of policies. Aetna does not require a physician’s referral to cover COVID-19 testing. Empire Blue Cross Blue Shield, which covers 4 million New Yorkers, does, said spokeswoman Alessandra Simkin. She said a clinician must deem the test medically appropriate based on an individualized clinical assessment, even though the federal government says health plans “generally must assume” that a patient seeking a COVID-19 test reflects such an assessment.
UnitedHealthcare—Sindhwani’s insurance company—said it waives cost-sharing for both in-network and out-of-network tests for members of Medicare Advantage, exchange, individual and employer-sponsored health plans. A spokesman for the insurer, which has more than 3.7 million members in New York, said tests must be ordered or reviewed by a health care professional and be used to diagnose COVID due to symptoms or potential exposure.
Sindhwani was not experiencing COVID symptoms when he got his test at CareCube, but he said he had just returned to New York from out of state and wanted to make sure he did not have the virus.
“It feels like I was misled,” he said.
CareCube did not respond to a request for comment before press time. Sindhwani still has not paid the bill.
Even patients with symptoms have faced testing costs. When Kate Sweeney started feeling rundown at the start of August, just after her first social outings since the start of the pandemic, she figured she should get tested. She went to the Bushwick location of Rapid NYC, an urgent care provider that she said touted free testing. She had been there twice or three times before for COVID tests and not had to pay.
She is now on the hook for $245, after Rapid NYC billed her insurance $75 for the test and $245 for the office visit; she had asked the center not to, because she knew it was out of network. Rapid NYC did not respond to a request for comment.
“I can’t deal with this every time I feel I should go get tested,” Sweeney said.
City Councilman Mark Levine, who chairs the council’s health committee, is worried the inconsistencies will dissuade New Yorkers from getting swabbed. He said the city should expand hours at its testing sites, which are free, and open more.
“Unfortunately, Delta means that vaccination, while critical, is alone not enough,” Levine said. “If people lose confidence in testing being accessible and no-cost, then it’s going to be a setback to this effort.”
The city Department of Health provided a statement encouraging New Yorkers to use city-run testing sites and Health + Hospitals facilities for free testing services. In a statement, the state Department of Health said public health insurance programs regulated by the agency cover diagnostic COVID-19 tests in keeping with the federal policy; it no longer runs its own testing sites but said New Yorkers can visit its website or call its COVID-19 hotline to find a nearby locations.
Source link : https://www.modernhealthcare.com/insurance/covid-19-testing-bills-surprise-new-yorkers
