How do I avoid paying through the nose for a COVID test?
The bad news: It’s possible to get socked with a four-figure bill. The good news: It’s possible to avoid that.
Holy crap, we don’t seem to be done with this COVID thing. I hope you’re doing OK. As I write this, my kid’s doing remote school for the first time since last spring. (So far, we’re doing OK as officemates-once-again. Ask me again in a week … or two or three.)
Meanwhile, there’s a lot of reasons you may want a COVID test: Worst-case, you maybe don’t feel so hot. (In which case: feel better soon! Really pulling for you to come through all this OK.)
But even best-case, you may have places to go, people to see, a job to get to. And everybody involved—including your employer, or an airline—may want to know if you’re carrying some virus-shaped baggage.
And as you may have seen—or even experienced—it’s possible to get hit with bats*** charges for the privilege of getting a swab jammed up your nose.
Here’s your guide to staying as safe as we get these days, financially and otherwise.
What kind of test do you want?
The two main flavors—PCR and antigen— can serve different purposes.
You’re probably already familiar, but: PCR tests are the ones you get from a medical provider. The sample goes to a lab and results come back… later. Best-case, later the same day. Worst-case, days later.
Rapid antigen tests you buy from a store, swab yourself and get results in maybe 15 minutes, like a home pregnancy test.
PCR tests are the most sensitive, but — as Dr. Celine Gounder, an infectious disease specialist and epidemiologist explained to me recently — that doesn’t mean they’re the best tool for every situation.
She calls PCR tests a great diagnostic tool, to guide treatment. If you’re feeling sick, they’re most likely to tell you: Could COVID be the reason? If you’ve been infected, they’re unlikely to miss it.
But if you’re feeling OK, then the big question is: Could I get someone else sick right now?
This is where rapid-antigen tests can give you a pretty-solid answer.
A negative result gives you a window of a few hours when you’re probably not carrying enough virus in your nose to make anybody else sick.
Those delayed results for PCR test results actually make them less-useful if you’re trying to see other people more safely. They tell you if you were negative when you took the test. If that’s a couple days ago, the answer could have changed.
That’s why Dr. Gounder says antigen tests can be a great public-health tool — because they quickly tell you whether a person is contagious to others right now.
But — you’re probably ahead of me here — rapid-antigen tests can be hard to find these days. And they’re so freaking expensive. The going rate is $23.99 for a two-pack, when you can find them.
At my house, we do our best to keep a stockpile of rapid tests. My mom’s 91, and we want to be able to see her without worrying that we’ll kill her. (Like us, she’s vaxxed and boosted, but that only gets a 91-year-old immune system so far.)
Where we’ve been able to get rapid tests (for a little less)
The best deal we’ve found was at walmart.com, for $14 a two-pack (shipping included when we bought online). Walmart, Kroger and Amazon promised the Biden Administration last September that they’d sell these tests “at cost”; Amazon pretty much never had them in stock. Walmart sometimes did, but that deal is over. 😡 They’ve bumped their price to $19.98.
Amazon does have a different brand of test for $18 a two-pack, which is still cheaper than I’ve seen elsewhere. They tend to be back-ordered a week or two.
As alternatives, these suck. Still expensive, just a little less so, and still hard to get.
Have you had luck finding tests? Share your tips.
This is especially frustrating because in other countries — including Mexico, Canada, South Korea, and most of Western Europe — these tests are cheap, and they’re everywhere. (If you’re curious about why this is so messed-up in the U.S., I got the scoop from two funny, smart ProPublica journalists.)
Help is on the way. Just not enough, and not soon enough.
With the rapid-antigen tests, the Biden administration has promised two things:
They’re going to send half a billion free tests to Americans.
Insurance will have to reimburse us for rapid tests we buy (if/when we can find them).
Which is better than nothing, but not great.
If the goal is to help us return to “normal,” then half a billion tests is nowhere near enough in our country of 330 million people.
And there’s no word, so far, on how soon the half-a-billion-free-tests will get here, or how you request one.
With insurance, a bunch of issues.
One, not everybody has insurance. That’s big.
Second, getting reimbursed by insurance sucks.
Finally, insurers may be able to set limits on how many tests they’ll pay for, per person, or how often you can test on their dime.
The administration says they’ll clarify these issues by Jan. 15. We’ll update this post when they do, so check back.
OK, what about PCR tests? Good news and less-good news
The good news is: If you’ve got insurance, they’re supposed to cover your COVID test 100 percent, most of the time. Even if you haven’t hit your deductible.
The bad news is: There are a lot of cases where you could get stuck with a bill. Here are a few, and what to look out for.
1. The “if you’ve got insurance” part.
Lots of people don’t have insurance.
Three pieces of OK news about this. The first two depend on where you live:
First, there are government-sponsored testing sites where anybody can get a free test. In some places. You’re probably already scouting around for this in your area. Your local media outlet is probably on the case too.
Second, 18 states will use Medicaid to pay for your COVID test if you’re uninsured (even if you don’t have Medicaid).
This is totally a glass-half-empty/half-full situation—except that it’s actually totally empty if you live in one of the other 32 states. A chart halfway down this page says which states are which.
Finally, there’s federal money to pay COVID-test bills for uninsured folks. Someone tries to bill you for one? Contact the billing office and suggest they send the bill to Uncle Sam, specifically the “COVID-19 Uninsured Fund.”
(I know: A fun opportunity to call a medical-billing office! And maybe get blown off! But I’m just saying: You have solid ground to stand on here, and it’s worth a freaking shot.)
2. The “most of the time” part. Beware of this exception.
In order for this insurance-has-to-cover-your-COVID test rule to be in effect, a “licensed medical professional” has to determine that you need a COVID test, according to Sabrina Corlette, who runs the Center on Health Insurance Reforms at Georgetown, and knows this stuff cold.
And for the rule to be in effect, you need a medical reason for seeking the test. In an email, she said “tests an employer might require for workplace safety” don’t qualify. “Same if your sole purpose for getting a test is to go visit grandma, or to travel.”
So if you go into a place and say, “My boss says everybody needs a COVID test to come back to work,” that might get you stuck with a bill.
Maybe instead, when anybody at the testing site asks you why you’re there… put it to them some other way. I’m just saying.
3. The “supposed to” part. Beware of extras, beware of sharks.
This starts with a bit of good news: The rules saying insurance is supposed to cover your PCR COVID test also say insurance is supposed to cover any “related services.” For example, if you’re at a doctor’s office or an ER, and there’s a charge for seeing the doctor at all? That’s supposed to be covered.
Some Emergency Rooms love to charge a “facility fee”—what ace New York Times reporter Sarah Kliff calls a “cover charge” for just walking in the ER door, and they can be a thousand bucks or more.
So, the good news: If you’re there to be tested for COVID, facility fees are supposed to be covered too.
There’s a potential hitch here: Medical billing is complex and weird, even for medical providers, even when they’re doing their best.
Depending on how their office writes up your bill, the insurance company may not conclude that COVID was the reason you showed up… and they may not cover everything.
So: Do your best to make sure everybody at the medical office or ER knows that’s why you’re there. Document whatever you can. And if you run into trouble with insurance, be ready to ask the doctor’s office to re-submit the bill to your insurance, with COVID-specific billing codes.1
And then… watch out for medical folks who are NOT necessarily on the up-and-up:
Sarah Kliff saw cases in her reporting where providers—especially free-standing ERs in states like Texas and Colorado—tacked on totally-unrelated services to visits for COVID tests.
When you’re getting seen at the ER, tell everyone you talk to: “I don't want you to run any tests or do any procedures or anything without running it by me. And I want an itemized bill while I'm here.”
Finally, one last warning: If the ER, or wherever you’re being seen, isn’t in your insurance network—isn’t covered by your plan—then none of these protections, where insurers have to pay for the facility fees and stuff if you show up for a COVID test, may apply to you.
When Sarah Kliff told me that, my head exploded. Like: I’m in the middle of a global pandemic that’s spreading super-fast, and hospitals are getting overwhelmed… but if I go to the wrong hospital’s ER for a COVID test, I could be on the hook for a bajillion dollars in facility fees?
She was like: Yeah, pretty much.3
Wait, there are more, newer, worse sharks
In Chicago, the Better Business Bureau said they were hearing about sites that were asking not just for money upfront — when the state is trying to fund lots of free testing sites — but for social security numbers. Just what you want with your COVID test: An identity-theft risk!
Chicago’s health commissioner told the local TV news: “"I would ask the question: ‘Are these tests FDA authorized?’ and ‘Which laboratory are you sending test results?’ [If] you get a sense they can't answer, that would be an obvious red flag."
Hey, are you mad yet? You’ve got every right to be.
This newsletter is called First Aid Kit for a reason. I’m here to give you the absolute best information I can, but it’s information about a system that’s horribly screwed up.
It’s really easy to get COVID right now, sadly. Even if you do all the “right” things, there’ a lot of factors that remain out of our control.
To stay sane and in the fight — remember it’s not your fault if you don’t have time to visit half a dozen drug stores to find a COVID test.
If you get exposed while standing in line at the grocery store — it’s not your fault. If you can’t afford to or can’t find enough tests to keep a stock at home — not your fault.
The system is firmly to blame here. We can make some choices to help keep ourselves safer, but we are not going to individually solve this crisis.
I’ll share one more bit of advice—the kind I pass around to my friends: Get a good mask. Make sure it fits. Specifically:
Avoid Amazon: There are a lot of fakes there.
A non-profit(!) called Project N95 sells real ones.
Check out the Mask Nerd, a mechanical engineer (specialty: aerosol science) who has tested hundreds of masks personally. He’s got a ton of helpful videos on YouTube. He links out to other reliable sellers of good masks.
He also likes Fix the Mask, a head strap that snugs up a surgical mask to your face, making it comparable to a good-fitting N95-type mask.
OK, that’s it! Pace yourself. Give yourself breaks and rewards. Looks like it’s gonna be a long year.
Want more detail?
Our Dec. 23 episode gives more detail on PCR vs antigen tests… and why the rapid tests are so expensive and hard to find. (Transcript here, if that’s more useful.)
This NYT story gives a LOT more on when and how you might want to test—PCR, antigen, all of it (if you can find a freaking test).
Sarah Kliff’s reporting for the Times on how to avoid a big bill for COVID tests is still the gold standard—and she updated it just last month. If you prefer to listen, here’s our interview with her about it.
Getting technical: Sabrina Corlette’s center at Georgetown has a long blog post about The State of COVID-19 Testing Coverage and Accessibility
In future First Aid Kit installments, we’ll talk about learning to read medical billing codes. For now, you may have to let Google be your guide on that.
I do have a piece of good news on this front: At the beginning of January, we got a new kind of protection, specifically from certain sky-high hospital bills, and could help with this specific problem, some. It’s called the No Surprises Act, and we’ll get into it later this month. It’s got gaps that’ll make you mad — they make me mad — but it’s an important upgrade.