The cost of a COVID-19 test should be fully covered by health insurance and a person should have no symptoms or exposure to someone who has tested positive for one.
“People can get a COVID-19 test from any provider at any time, on or off the network for your health plan,” said Rachel Arrezola of the California Department of Health Care.
The new federal guidance published in February “clarified” this point, as previous rules sculpted some exceptions: health insurance companies had to cover “medically adequate” evidence, but apparently they didn’t always have to cover the costs of travel, back-to-work, back-to-school, sports or public health surveillance tests.
New coronavirus diagnostic tests are usually done with a nasal swab and an active infection is sought.
The Santa Barbara County Department of Public Health reports the number of people who test positive each day, which reached 779 on Jan. 11 and was six on Monday.
COVID-19 vaccine messages have consistently repeated the message “safe, effective, and free,” but free testing has not had the same level of attention.
The state’s COVID-19 website has not been updated to include DMHC information that health plans are expected to cover testing without out-of-pocket costs.
The COVID-19 page of “Health and Coverage” states: “If you have symptoms of COVID-19 or think you were exposed to it, the tests are free. In all other circumstances, you may have a copayment. “
The DMHC has an information sheet on free trials of COVID-19, and these are the main points, Arrezola said last week:
»You should not pay anything for a COVID-19 test, including a copayment or a deductible payment. You do not need to meet your deductible to get a COVID-19 test at no cost to you.
»You do not need to have symptoms of COVID-19 or possible exposure to COVID-19 for your health plan to cover a COVID-19 test.
»You do not need to be an“ essential worker ”for your plan to cover COVID-19 tests.
“If a health plan enrollee receives an invoice related to the coverage of a COVID-19 test, they should first file a complaint with their health plan and include a copy of the bill,” according to the DMHC. “Your health plan will review the complaint and you should make sure that the person enrolled will be reimbursed.
(Photo from the California Department of Health Care)
“If registrants do not agree with your health plan response or if the plan takes more than 30 days to resolve the issue, they should file a complaint with the DMHC Help Center at www.HealthHelp.ca. gov o 1.888.466.2219.
“If a health plan member received a charge prior to the publication of the new federal guidance, we encourage them to continue to contact their health plan and the DMHC Help Center for assistance. DMHC help will work with your health plan to reimburse the enrolled person “.
For the uninsured, the government pays all necessary tests and care for COVID-19, depending on the state.
Noozhawk asked readers about their experiences charging for a new coronavirus test and about 30 people responded, including some who said they paid out of pocket for a test from a Santa Barbara County provider.
Many of them used urgent care clinics to do a test, where appointments have been easy to get or consultations are available.
In some cases, health insurance covered part of the bill for a local COVID-19 test, but not all. For others, health insurance plans did not cover the cost of the tests or providers billed patients directly and did not file claims with the health insurance company.
Most of these tests were done before February, so it is possible that some of the bills will be reimbursed by health insurance plans and others will be exceptions to federal consumer protections.
The Santa Barbara County Department of Public Health issued a guide for deciding if a person should take a COVID-19 test and where to find one.
Katie Newendorp said she was tested at the Goleta MedCenter Urgent Care Clinic and her health insurance plan was later billed for the test and the office visit.
His insurance was billed at $ 140 and his adjusted charge, which he had to pay, was $ 78.69.
“I never questioned the bill because I didn’t know I should. Are the tests supposed to be free? “he wrote in an email exchange with Noozhawk.
Several people who responded to the Noozhawk questionnaire said they had to pay a portion of the bills for the CVS Goleta pharmacy tests, where people have to be blown to the nose.
A couple paid $ 139 each to take a test before traveling to Hawaii and told Noozhawk that their Medicare insurance would not pay for CVS tests.
Medicare pays for all COVID-19 diagnostic tests, depending on the state, but travel-related tests may not have been specifically covered before the new federal guidance in February.
Others who were tested in this CVS told Noozhawk that they charged out-of-network labs that processed the test sticks and had to pay part of the costs.
(Photo from the California Department of Health Care)
Amy Travis said she tested the CVS Schooner and had to pay a portion of the $ 100 bill from Helix, the San Diego company that processed the sampling, because it was offline for its health insurance company.
“It surprised me because obviously I would have no way of knowing who was using CVS to process the test, but it cost $ 22.60 and more pain to fight Blue Shield about it, although maybe it did,” he wrote. in an email exchange. with Noozhawk.
Off-network providers are not required to bill insurance companies directly for insurance, so people may have to pay in advance and file insurance claims to reimburse them, according to the Family Foundation. Kaiser.
“Patients who don’t know how to manually submit claims offline or who are too ill to do so may not be successful,” according to a KFF analysis updated on April 28th.
Where to find COVID-19 tests in Santa Barbara County
Testing has always been free for everyone, with or without health insurance coverage, at state-run OptumServe testing sites, including those in Santa Maria, Lompoc, Goleta, and the mobile site currently in the Chase Palm Park parking lot in Santa Barbara. and East Beach.
These sites and additional access sites are displayed on the county website here: https://publichealthsbc.org/testing/
The test site status map includes the sites listed above, as well as medical offices, clinics, pharmacies, and hospitals that offer test appointments.