The cost of a COVID-19 test should be fully covered by health insurance, and a person doesn’t have to have symptoms or exposure to someone who tested positive to get one.
“Individuals can get a COVID-19 test from any provider at any time, in or out of your health plan’s network,” said Rachel Arrezola of the California Department of Managed Health Care.
New federal guidance issued in February “clarified” this point, since previous rules carved out some exceptions: Health insurance companies had to cover “medically appropriate” testing but apparently didn’t always have to cover the costs of testing for travel, return to work, return to school, sports, or public health surveillance.
Novel coronavirus diagnostic testing is typically done with a nasal swab, and it looks for an active infection.
The Santa Barbara County Public Health Department reports the number of people who test positive each day, which peaked at 779 on Jan. 11 and was six on Monday.
COVID-19 vaccine messaging has consistently repeated the “safe, effective, free” message, but no-cost testing has not had the same level of attention.
The state’s COVID-19 website has not been updated to include the DMHC information that health plans are expected to cover testing with no out-of-pocket costs.
The “Healthcare and Coverage” COVID-19 page states, “If you have COVID-19 symptoms or think you were exposed to it, testing is free for you. In all other circumstances, you may have a co-pay.”
The DMHC has a fact sheet on free COVID-19 testing, and these are the main points, Arrezola said last week:
» You should not pay anything for a COVID-19 test, including a co-pay or payment toward a deductible. It is not required that you have met your deductible to get a COVID-19 test at no cost to you.
» You do not need to have COVID-19 symptoms or possible exposure to COVID-19 for your health plan to cover a COVID-19 test.
» You do not need to be an “essential worker” for your plan to cover COVID-19 testing.
“If a health plan enrollee receives a bill related to the coverage of a COVID-19 test, they should first file a grievance with their health plan and include a copy of the bill,” according to the DMHC. “Their health plan will review the grievance and should ensure the enrollee is reimbursed.
(California Department of Managed Health Care photo)
“If the enrollee does not agree with their health plan’s response or if the plan takes more than 30 days to fix the problem, they should file a complaint with the DMHC Help Center at www.HealthHelp.ca.gov or 1.888.466.2219.
“If a health plan enrollee received a charge prior to the issuance of the new federal guidance, we encourage them to still contact their health plan and the DMHC Help Center for assistance. The DMHC Help Center will work with their health plan to reimburse the enrollee.”
For the uninsured, the government pays for all necessary COVID-19 testing and care, according to the state.
Noozhawk asked readers about their experiences getting charged for a novel coronavirus test, and about 30 people responded, including some who said they paid out of pocket for a test from a Santa Barbara County provider.
Many of them used urgent care clinics to get a test, where appointments have been easy to get or walk-ins are available.
In some cases, health insurance covered part of the bill for a local COVID-19 test, but not all of it. For others, health insurance plans reportedly did not cover the cost of testing, or providers billed patients directly and did not file claims with the health insurance company.
Most of these tests were done before February, so it’s possible that some of the bills should be reimbursed by health insurance plans and others are exceptions to federal consumer protections.
The Santa Barbara County Public Health Department issued a guide for deciding whether a person should get a COVID-19 test, and where to find one.
Katie Newendorp said she was tested at the Goleta MedCenter urgent care clinic, and her health insurance plan was billed later for the test and office visit.
Her insurance was billed $140 and her adjusted charge, which she had to pay, was $78.69.
“I never questioned the bill because I didn’t know that I should. Is testing supposed to be free?” she wrote in an email exchange with Noozhawk.
Several people who responded to the Noozhawk questionnaire said they had to pay a portion of their testing bills from the Goleta CVS pharmacy drive-thru, where people have to swab themselves up the nose.
One couple paid $139 each for a test before traveling to Hawaii, and told Noozhawk their Medicare insurance wouldn’t pay for the CVS tests.
Medicare pays for all diagnostic COVID-19 tests, according to the state, but travel-related tests may not have been specifically covered before the new federal guidance in February.
Others who were tested at that CVS told Noozhawk they were charged for the reportedly out-of-network laboratories that processed the testing swabs, and they had to pay part of the costs.
(California Department of Managed Health Care photo)
Amy Travis said she got a test at the Goleta CVS and she was required to pay a portion of the $100 bill from Helix, the San Diego company that processed the specimen swab, because it was out-of-network for her health insurance company.
“I was surprised since I obviously would have no way of knowing who CVS used to process the test, but it was $22.60 and more of a pain to fight with Blue Shield about it, though perhaps I should,” she wrote in an email exchange with Noozhawk.
Out-of-network providers are not required to bill insurance companies directly for testing, so people may have to pay up front and submit claims to insurance for reimbursement, according to the Kaiser Family Foundation.
“Patients who don’t know how to manually submit out-of-network claims or who are too sick to do so may not succeed,” according to a KFF analysis updated on April 28.
Where to Find COVID-19 Testing in Santa Barbara County
Testing has always been free for everyone, with or without health insurance coverage, at the state-run OptumServe testing sites, including the ones in Santa Maria, Lompoc, Goleta, and the mobile site that is currently at Santa Barbara’s Chase Palm Park parking lot at East Beach.
Those locations and additional walk-up sites are all listed on the county website here: https://publichealthsbc.org/testing/
The state’s map of testing locations includes the sites listed above as well as doctor’s offices, clinics, pharmacies and hospitals offering testing appointments.