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Loopholes Saddle Some with Surprise Bills for COVID Tests

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COVID-19 tests should cost nothing if you have health insurance, but some people have been billed for related fees through loopholes in the system. (Adobe Stock)
COVID-19 tests should cost nothing if you have health insurance, but some people have been billed for related fees through loopholes in the system. (Adobe Stock)
November 30, 2020

LEXINGTON, Ky. -- With or without insurance, some residents are receiving surprise medical bills for fees related to COVID-19 testing. Legal experts say those bills should be contested and explain why loopholes in the law could result in expensive bills.

Under the Families First Response Act and the CARES Act, along with Gov. Andy Beshear's executive orders, no Kentuckian should have to pay a co-pay or be billed for coronavirus testing. Surprise medical bills often occur when services are provided by out-of-network labs or doctors.

Betsy Davis Stone, health law fellow with the Kentucky Equal Justice Center, said her husband was billed more than $162 for a COVID-19 test earlier this year. Stone sent an appeal letter to the insurance company on behalf of her husband. She said the company made an exception, but maintained the charge was valid.

"But essentially their letter said, 'We think there's a loophole in the CARES Act and the federal act that allows us to do this, because while it says no cost-sharing, our plan doesn't define cost-sharing as out-of-network charges. So out-of-network charges don't fall under that,'" Stone said.

Some providers also charge facility fees or other fees that can show up on a bill. Stone said a template is available on the Kentucky Equal Justice Center's website that people can use to appeal any medical bill related to coronavirus testing.

The template is available at kyequaljustice.org. Local legal-aid organizations also may be able to help.

Stone said patients can ask questions to ensure they won't be billed, and confirm lab tests will be sent to an in-network provider. But she said it's unrealistic and unfair to place the burden of navigating a complex health care system onto consumers.

She said both state and federal legislation have been proposed in recent years to stop surprise medical bills.

"These bills often get stymied by insurance companies not wanting to move through the process, because this is a really good way for insurance companies to make money," Stone said. "But also sometime providers are really hesitant to want to change the status quo, too."

And it's not just testing. Many Americans are struggling to pay off medical debt related to coronavirus treatment. One new study found some hospitals are charging patients significantly more than the cost of care during the pandemic.

Nadia Ramlagan, Public News Service - KY