In March, Congress passed legislation aimed at requiring for-profit health insurance companies to cover all FDA-approved coronavirus tests with no cost-sharing—but federal laws have not stopped insurers from hitting vulnerable Americans with large surprise bills during an ongoing pandemic and economic crisis that pushed millions to the brink of financial ruin.
"This isn't just about coronavirus—it's about the universal fragmentation of U.S. health financing. 'Falling through the cracks' isn't the exception in the U.S.—it's a fundamental feature of the system. It's how it is designed."
—Dr. Adam Gaffney, Physicians for a National Health Program"If I had to pay it off, it would clear out my savings," New York City resident Kelly Daisley told the New York Times after Anthem charged her $2,718 for a Covid-19 test that was advertised as free.
Under the Families First Coronavirus Response Act and the CARES Act, private insurers are supposed to shoulder the all of the costs of coronavirus tests, including those offered by out-of-network providers. But the laws—and the Trump administration's narrow interpretations of them—are rife with loopholes that insurance giants have not hesitated to exploit, potentially leaving hundreds of thousands of Americans with unanticipated charges.
As Sarah Kliff of the Times reported Wednesday, "In some cases, the charges appear to violate new federal laws that aim to make coronavirus tests free for privately insured patients. In other cases, insurers are interpreting gray areas in these new rules in ways that work in their favor." Insisting they are not deliberately flouting the law, insurers "faulted the complexity of American medical billing," Kliff noted.
"Some patients found that insurance covered the test but denied payment for other services that went with it: another billing decision that could violate federal law," Kliff wrote. "One mother in California was surprised that her daughter's coronavirus test was fully covered but that a $49 'after hours' fee was not—the clinic said it provided tests only in the evening, so as to not infect other patients."
On Twitter, Kliff wrote that patients she interviewed for her story "reported about $3,000 in total medical debt from coronavirus tests they expected to be free."
"After facing questions from the Times," Kliff added, "insurers reversed course and covered all the patients' bills."
The insurers' reversals indicate the bills should not have been sent in the first place and raise questions about how many other people across the U.S. have been billed for Covid-19 tests that are supposed to be free under federal law.
"About 2.4 percent of coronavirus tests billed to insurers leave the patient responsible for some portion of payment, according to the health data firm Castlight," Kliff reported. "With 77 million tests performed so far, it could add up to hundreds of thousands of Americans who receive unexpected bills."
Across the country, patients are experiencing illegal charges and denied claims for their coronavirus tests.
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— Sarah Kliff (@sarahkliff) September 9, 2020
Adam Gaffney, a critical care doctor and president of Physicians for a National Health Program (PNHP), said the fact many Americans are still receiving surprise bills from Covid-19 tests is an indictment of both Congress' "utterly inadequate" legislating and the nation's deeply flawed for-profit healthcare system.
"This isn't just about coronavirus—it's about the universal fragmentation of U.S. health financing," Gaffney tweeted Wednesday. "'Falling through the cracks' isn't the exception in the U.S.—it's a fundamental feature of the system. It's how it is designed."
"In Canada or the U.K., there are no cracks of this sort: billing the patient like this is simply not allowed," Gaffney continued. "'Universal healthcare' doesn't just mean providing the 30 million currently uninsured with coverage—it requires seamless, unified, equitable coverage for all. That's one of many reasons why single-payer matters."
In contrast, the idea of a system based on regulated private insurance would be a failure. If we can't even regulate insurers into covering coronavirus testing, why would we possibly think we could regulate them into providing universal, comprehensive, equitable coverage?
— Adam W Gaffney (@awgaffney) September 9, 2020
In June, as Common Dreams reported, the Trump administration issued policy guidance (pdf) telling private insurers that under the Families First Coronavirus Response Act, they are only required to cover "medically appropriate" coronavirus screenings, not tests "conducted to screen for general workplace health and safety (such as employee 'return to work' programs)."
Democratic lawmakers and advocacy groups were quick to denounce the Trump administration's interpretation of the law, which opened the door to the kinds of surprise bills that people across the U.S. are now receiving.
Rep. Frank Pallone Jr. (D-N.J.) said in June that the Trump administration's reading of the law was a clear violation of congressional intent that gave "a free handout to the insurance industry."
"Once again," Pallone tweeted at the time, the Trump administration was "prioritizing corporate profits over people."