Heres why your next coronavirus test might not be covered by insurance – SILive.com

STATEN ISLAND, N.Y. -- Did you receive an unexpected bill for your most recent coronavirus (COVID-19) test? Youre not the only one.

In the majority of cases, insurance companies are federally mandated to cover all costs associated with coronavirus testing.

However, there are some exceptions to the rules that could result in Americans paying hundreds, or in some cases thousands, of dollars for routine coronavirus tests.

Under the federal guidance, insurance companies are required to cover all associated costs of medically-necessary coronavirus testing, even if a patient is asymptomatic and has had no known exposure to the virus.

This guidance makes clear that private group health plans and issuers generally cannot use medical screening criteria to deny coverage for COVID-19 diagnostic tests for individuals with health coverage who are asymptomatic, and who have no known or suspected exposure to COVID-19. Such testing must be covered without cost sharing, prior authorization, or other medical management requirements imposed by the plan or issuer, according to the Centers for Medicare and Medicaid Services (CMS).

Even if an individual is asymptomatic and has had no known exposure to virus, the test will be deemed medically-necessary following an individualized clinical assessment.

For example, covered individuals wanting to ensure they are COVID-19 negative prior to visiting a family member would be able to be tested without paying cost-sharing, the CMS says.

The guidance also states that insurers must cover all medically-necessary point-of-care coronavirus tests and tests taken at state or locally administered testing sites.

However, the guidance clearly states that insurance companies are not required to cover all costs for coronavirus tests related to public health surveillance programs or return-to-work requirements.

Plans and issuers are not required to provide coverage of testing such as for public health surveillance or employment purposes. But there is also no prohibition or limitation on plans and issuers providing coverage for such tests. Plans and issuers are encouraged to ensure communications about the circumstances in which testing is covered are clear, according to the guidance.

With many Americans now returning to the office, and weekly coronavirus testing set to be required for unvaccinated workers in the majority of work settings, millions of unvaccinated residents could be forced to pay out-of-pocket for the coronavirus tests theyll need in order to keep their job.

Such limits mean some patients with health coverage may nonetheless receive bills for COVID-19 diagnostic testing and related services, and those bills often can be widely different from patient to patient, according to a recent study from the Peterson-KFF Health System Tracker.

The study conducted an analysis of the costs of coronavirus tests across the country, finding that prices ranged drastically from as low as $20 to as high as $1,419 for a single diagnostic test.

Nearly half, 47%, of tests ranged between $100 and $199, but one in five, 20%, were priced at $300 or more, according to the study.

Those costs could start to pile up for unvaccinated workers who require weekly screenings if their insurance company elects not to cover the costs of the tests.

A New York Times report found that insurance companies have generally been willing to cover the costs of these employer-mandated tests, but that could soon change.

If they are starting to see a significant number of people who have these tests submitted every week, or twice a week, under federal law they would be within their authority to say, this looks like routine workplace testing, and not cover it, Sabrina Corlette, a research professor at Georgetown Universitys Center on Health Insurance Reforms, told the Times.

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Heres why your next coronavirus test might not be covered by insurance - SILive.com