(WXYZ) — New laws mean coronavirus testing is supposed to be done at no cost to you. But is that really working? We recently asked you to send us your COVID bills, and discovered that coverage isn’t totally clear for several reasons.
“It was quite scary,” said Dena Leath. The mother from Ann Arbor is grateful that she and her daughter both survived the coronavirus.
“We pretty much have physically recovered, but your stamina, you really don’t get it back,” said Leath.
Leath also says she’s still stressed out because of an outstanding medical bill for her 19-year-old daughter, Simone.
“[It’s] a real big headache that I don’t need,” Leath told 7 Investigator Heather Catallo.
Leath says back on April 2, 2020, she and Simone went to Michigan Medicine’s emergency room. Leath says she was tested for the coronavirus with a nasal swab. Leath was positive.
But she says Simone was sent to the pediatric ER.
“She explained to them that we were together, and I was over in the adult ER, at which time I guess they didn’t think that she warranted a test,” said Leath.
Because coronavirus tests were in short supply in early April, Leath says she was told to act as though that Simone had COVID19 as well.
“We were told that she could not be tested, and she would be listed as probable,” said Leath.
Leath’s test at the University of Michigan was 100% covered by her insurance. But she still got a bill from the hospital for Simone, charging her $125. The insurance codes listed for the teen’s care do not include coronavirus.
“The policy of the state is really to try to get everyone covered,” said Anita Fox, Director of Michigan’s Department of Insurance and Financial Services. “We’ve been working with the insurance companies, and have had a good cooperative response from them in agreeing to make sure that financial costs are not a barrier to people getting the testing and care they need during this extraordinary health crisis.”
Fox says “probable” COVID cases should be covered.
“I believe that all Michigan carriers have agreed, almost every one, that there wouldn’t be co-pays or deductibles for that COVID care as well. It’s not just for the testing, it’s also for treatment,” said Fox.
Fox says if you’re having trouble with a bill, the state can step in.
“In many cases, we’ve been able to resolve these the same day,” said Fox.
Experts also say that if your doctor or testing location accepted Provider Relief Funds from the federal CARES Act, they can’t bill you for the balance of the care after your insurance pays it’s portion.
“No balance billing for any COVID patient, OR presumptive COVID patient. A presumptive seems to mean a patient where the physician goes ahead and puts that diagnosis down, even in the absence of a test,” said Dr. Jack Hoadley, professor at Georgetown University’s Health Policy Institute.
Hoadley also recommends watching out for “facility fees” at places like Urgent Care centers or hospitals out of your network.
“There’s the normal charge for the physician encounter, the normal charge for the lab actually running the test. The facility, whether it’s a hospital or urgent care center can charge a facility fee on top of that. And that’s not necessarily a wrong thing. There’s a cost to them to just have that facility in place, have the stand by capacity. But that’s something that anybody paying for healthcare costs, particularly an employer… needs to be aware of and look at,” said Hoadley.
So here’s the Rebound Rundown.
- Under the federal CARES Act, since March 18th, insurance companies have been required to pay for coronavirus testing.
- Probable cases should be covered, but you may need to check with your doctor about how the test and services were coded. Make sure they used a coronavirus code when your insurance is billed.
- Try contacting your insurance carrier first about a bill.
- If you can’t resolve the bill, contact the state’s Department of Insurance and Financial Services at 1-877-999-6442 or on their website.
In Leath’s case, Simone’s bill was not coded as a COVID diagnosis, but the codes used are for viral symptoms related to the disease.
Because Michigan Medicine accepted $116,857,156 in Provider Relief Funds, experts say they are not allowed to balance bill for COVID-related cases.
“I understand this is new to everyone. That’s why I’m speaking out, to advocate and it may someone else that’s going through the same situation,” said Leath.
After the 7 Investigators reached out to Michigan Medicine, they agreed to review Leath’s bill, and sent us this statement from Jeff Desmond, M.D., Chief Medical Officer of Michigan Medicine.
“Michigan Medicine is following the requirements of the CARES Act and takes this very seriously. Right after the CARES Act was approved on March 27, we began educating our billing team on all of the new information from both the federal government and insurers. We appreciate being alerted to this issue and are reviewing this case and will make any corrections needed and resubmit the bill to insurers. We work diligently with our patients on any financial issues and have reached out to the family.”
Additional Coronavirus information and resources:
Click here for a page with resources including a COVID-19 overview from the CDC, details on cases in Michigan, a timeline of Governor Gretchen Whitmer's orders since the outbreak, coronavirus' impact on Southeast Michigan, and links to more information from the Michigan Department of Health and Human Services, the CDC and the WHO.
View a global coronavirus tracker with data from Johns Hopkins University.
Find out how you can help metro Detroit restaurants struggling during the pandemic.
See all of our Helping Each Other stories.
See complete coverage on our Coronavirus Continuing Coverage page.