CHAMPAIGN — While the COVID-19 spotlight has shifted in recent months from testing to vaccines, health officials have continued to urge testing to help limit the spread of infections in communities.
But are tests still free?
The answer is, generally, yes. But there are some exceptions.
Under recently updated Biden administration guidance, health insurers must cover the cost of a COVID-19 test administered or authorized by a health care provider — without any cost-sharing or imposing any requirements such as prior authorization needed. That’s regardless of whether COVID-19 symptoms are present or if there’s been a known or suspected COVID-19 exposure.
The update served to clarify that insurers can’t impose out-of-pocket costs on their members who are tested when they’re asymptomatic or haven’t necessarily been exposed to a positive case, according to the Centers for Medicare and Medicaid Services.
Insurers are still allowed to impose out-of-pocket costs, however, when testing has been done for the purpose of public-health surveillance or for tests required by employers.
Carle spokeswoman Jamie Mullin said surveillance testing was more of a factor during early months of the pandemic.
And in practical terms, it would be difficult for insurers to know if a test has been done for employment purposes unless, perhaps, the test was done at a workplace, according to Sinead Madigan, chief operating officer at Health Alliance Medical Plans.
Bottom line, Health Alliance covers “medically necessary” tests without cost-sharing to members, Madigan said.
What makes it medically necessary: the involvement of a medical provider authorizing the test, Mullin said.
Mullin said Carle’s $175 charge for a COVID-19 test is all for the lab fee, and that is billed to the patient’s health insurer.
Uninsured patients aren’t billed, but Carle does seek reimbursement from the federal government for the cost of their test, Mullin said.
“My understanding is no one should receive a bill for that test,” she said.
Patients can be billed in connection with testing administered at Carle Foundation Hospital or in a convenient-care setting, but that wouldn’t be for the test itself, Mullin said. It would be for their standard out-of-pocket charges for a convenient-care or hospital visit, she said.
Prior to the updated guidance, some patients might have received a bill for part of the cost of COVID-19 testing done by Carle if they were asymptomatic or didn’t have direct exposure to someone with COVID-19, Mullin said.
Those seeking testing outside those circumstances have been directed throughout the pandemic to get tested at the state-sponsored community testing site at Market Place Mall.
Mullin recalled Carle being very specific about that early on, so that no patient would receive a surprise bill. The Champaign-Urbana Public Health District and other providers advised the same.
At the state drive-up facility, testing continues to be available at no charge to the patient, regardless of the reason for the test and whether people have health insurance or not, according to the health district.
Christie Clinic charges $105 to $154 for COVID-19 tests, and also bills patients’ insurers for that. That fee is for the cost of collecting the specimen, with the higher charge for the rapid test, according to Clinical Services Director Michelle Antonacci.
Most insurers have agreed to waive any cost-sharing for the test, she said, so there wouldn’t be a cost to the patient.
Christie Clinic is currently only doing testing under certain circumstances, though.
Lower demand for testing recently prompted Christie to close its outdoor drive-up site at 1801 W. Windsor Road, C, Antonacci said.
“Currently, Christie Clinic patients have testing ordered by their provider and are being directed to the Carle drive-thru for COVID-19 testing, with the exception of pre- operative and pre-procedural patients,” she said. “These tests are sent to Carle’s laboratory for processing.”
OSF HealthCare charges $165 for a self-pay office visit at its Urgo convenient-care centers, and for patients seeking COVID-19 testing that would include the cost of the test and an evaluation by a provider who would deem what testing is appropriate.
The charge can also be billed to the patient’s health insurer and uninsured patients aren’t billed, according to Laurie Hurwitz, OSF’s senior vice president of revenue cycle.
OSF is providing testing only when the test is considered medically necessary, and it never bills patients for medically necessary tests, Hurwitz said.
It’s important for patients to know if they do receive a bill from OSF for an uncovered portion of a medically necessary COVID-19 test, they should call their insurer and/or OSF to point out the error and get it corrected, she said.
“For a COVID test that is medically necessary, there is no circumstance when the patient should have to pay for the test,” she said.
Madigan also urged any Health Alliance members who are billed an out-of-pocket charge for a COVID-19 test to get in touch and find out why that charge was applied.
Starting last month, the University of Illinois began making its COVID-19 saliva tests available to family members of UI students, faculty and staff at a charge of $10 per test, and the charge is billed to the home of the related UI student, faculty or staff member.
That’s the same amount per test the UI is charging Champaign County for the testing now available to county employees.
The UI isn’t billing anyone’s health insurers for these tests, UI spokeswoman Robin Kaler said.