Author Topic: Testing cost-sharing laws and regulations  (Read 504 times)

Paul der Krake

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Testing cost-sharing laws and regulations
« on: October 22, 2020, 09:44:09 PM »
Got a bill from a clinic (The Little Clinic) for a COVID test taken on the road two months ago. The bill shows:
- specimen handling $9
- office visit, new patient $104
Then the usual adjustment and payment from the BlueCross affiliate in the state where the test was taken. We have an ACA PPO plan through the BlueCross affiiliate in our home state. The balance due shown is magically exactly our usual copay amount of $15.

Am I right in thinking this is a "mistake"?

I found the following summary of how testing costs are supposed to work now:

Quote
Since the passage of the Families First Coronavirus Response Act (FFCRA) on March 18, most people should not face costs for the COVID-19 test or associated costs. Starting on March 18 and lasting for the duration of the public health emergency, all forms of public and private insurance, including self-funded plans, must now cover FDA-approved COVID-19 tests and costs associated with diagnostic testing with no cost-sharing, as long as the test is deemed medically appropriate by an attending health care provider. This includes high-deductible health plans and grandfathered plans, but does not apply to short-term, limited duration plans. As outlined by CMS in a series of FAQs, there is no limit on the number of COVID-19 tests that an insurer or plan is required to cover for an individual, as long as each test is deemed medically appropriate and the individual has signs or symptoms of COVID-19 or has had known or suspected recent exposure to SARS-CoV-2. Federal guidance does not require coverage of routine tests that employers or other institutions may require for screening purposes as workplaces reopen.

Tell me why I'm wrong and I owe those $15.


Sibley

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Re: Testing cost-sharing laws and regulations
« Reply #1 on: October 26, 2020, 01:33:48 PM »
Call and ask. Medical coding is complex, it could be a legit error.

Paul der Krake

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Re: Testing cost-sharing laws and regulations
« Reply #2 on: October 26, 2020, 03:21:01 PM »
Update: I called. They said to call back in a week so the billing team can look at it.

I'm pretty sure I'm right and they can't charge squat. Hopefully this serves as a heads up to others.

Blonde Lawyer

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Re: Testing cost-sharing laws and regulations
« Reply #3 on: October 26, 2020, 07:18:04 PM »
You are a better person than I am.  I'd pay more than $15 to not have to deal with my health insurance company and a billing company!

cool7hand

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Re: Testing cost-sharing laws and regulations
« Reply #4 on: October 27, 2020, 04:05:04 AM »
Please keep us posted. A win against an insurance company should be celebrated!