While Congress passed a law to ensure no one would avoid getting tested for the coronavirus because of the cost, experts say loopholes and mix-ups have left some people with big bills to pay. People returning to their jobs also could wind up having to pay for COVID-19 tests, they warned.
Miki Kikuta made a trip to Japan in late January, as she does once a year. But this time, she said, she came back seriously ill.
“I just got off the plane. I go to bed. It was around midnight. So maybe like six hours after, I had a really high fever. It was 104 degrees,” Kikuta said.
Because Japan was already reporting cases of COVID-19, she went to the hospital to make sure she wasn’t infectious, and doctors ran some tests.
“The doctor came into my room and said, ‘Hey, good news, you don’t have the coronavirus.’ I was like, ‘Oh okay, I don’t have COVID-19,'” she recalled.
But later, Kikuta got a bill for over $2,400.
She said she learned that although her doctors did run tests on her, they did not test her for the coronavirus that causes COVID-19, apparently due to restrictions that were in place on testing back in February. She said because of that, her insurance company, Blue Cross Blue Shield of Illinois, would not fully cover the bill for her hospital visit.
“I wouldn’t have gone to the ER if I didn’t go to Japan or if COVID-19 wasn’t even a thing,” Kikuta said. “But I knew how contagious it was, and, you know, you can kill someone if you expose someone else if you had it. … So now I’m just stuck with this big bill that they don’t even want to try — even to do anything about, honestly.”
Stories like hers are cropping up, despite the fact that under legislation passed by Congress in March, COVID-19 tests and related charges are supposed to be covered.
Congress’ promise is not holding up, said Sabrina Corlette, co-director at Georgetown University’s Center on Health Insurance Reforms.
“There are far too many people who are either falling through the cracks because of some of these loopholes that the health plans are taking advantage of, not to pay for it,” she told “CBS This Morning” consumer investigative correspondent Anna Werner.
Alex Goodman went to a Colorado emergency room in April after struggling to sleep for a couple of nights.
“It felt like it was because it was difficult for me to breathe, like as if I couldn’t breathe in as much,” Goodman said.
Doctors did a COVID-19 test, but Goodman, too, got a bill from his insurance company.
“It said that my total was a bit over 3,000 or so,” he said. “That was the amount that I was going to have to pay.”
Goodman, a NASA employee, did a little digging and reached out to Dr. Kao-Ping Chua, a doctor who wrote an article warning about billing problems.
“I want people to know, first and foremost, that if they get a COVID test, they should not pay for that test and they should not pay for the visit. If they do get a bill for even the test with the visit, they need to call their insurer and contest the bill,” Chua said.
Goodman did just that. His insurance company Anthem Blue Cross reversed the bill in just a few days.
But some leading members of Congress say recent administration guidance on insurance company payments for testing presents a new, bigger problem. In a letter sent this week to three members of President Trump’s cabinet, five congressional Democrats say the administration wrongly claimed “COVID-19 testing for surveillance or employment purposes are not required to be covered” under the Families First Coronavirus Response Act.
The lawmakers said “there have been troubling reports regarding some health plans refusing to provide coverage of tests,” including for “employee return to work programs.”
“It is a huge problem,” Corlette said. “You know, it’s one of these crazy situations where we have a lot of people who are going to be required to get a test to get back to work, but there’s no requirement that their employer plan pay for it.”
Kikuta did get her bill paid. She said after refusing to pay for three months, Blue Cross Blue Shield of Illinois reversed course this week, one day after CBS News called to ask about her case. The company told CBS News in a statement that all customers have the right to appeal if they feel they were wrongfully denied any benefits.
Anthem Blue Cross told CBS News in a statement that if members feel their bills should have been waived, it is “encouraging them to reach out” and “raise the issue or to file an appeal.”
A Department of Health and Human Services spokesperson told CBS News the letter from congressional members failed to make a distinction between diagnostic and surveillance testing. Insurance companies are required to cover diagnostic testing for their members without imposing any cost-sharing, but surveillance screening is performed as a public health activity, which is funded differently, the spokesperson said.
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