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Waukesha man fights charge for COVID-19 test for second time despite CARES Act coverage

Posted at 1:26 PM, Aug 05, 2021
and last updated 2021-08-05 19:32:36-04

WAUKESHA — Besides the exception of voluntary rapid-result testing for travel, if you need to take a COVID-19 test, you shouldn't have to pay. The cost is covered under the federal CARES Act. But Joe Burke of Waukesha, turned to our I-Team after he says he was charged for the test twice now.

Burke said back in February one of Burke's daughters had cold-like symptoms. Her school wanted her to take a COVID-19 test as a precaution. She did and it came back negative.

"A couple of months later we received a bill for her urgent care visit," said Burke.

The bill, which Burke showed to the I-Team was for $128.46. At the time, Burke mistakenly paid it. He called his daughter's medical provider, ProHealth, and asked for a refund.

"The test was covered, however the office visit, the urgent care visit was not," Burke said he was told.

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By now, Burke was familiar with this. Last September, the I-Team helped him get a $266.88 bill removed -- a charge he received for his COVID-19 test.

His medical provider billed him using the medical codes for "pain unspecified" and for "acute pharyngitis" or a sore throat.

"People going to a doctor's office, for instance, for an appointment, and being charged for a first appointment rather than a COVID-19 test," said Caitlin Donovan with the Patient Advocate Foundation.

Donavan says her agency has received complaints from consumers after medical providers tacked on facility fees. She says that was more common earlier in the pandemic.

"Consumers should know that they shouldn't be charged for any out-of-pocket costs for a COVID-19 test at this point," she stressed.

Not only is coverage of diagnostic testing for COVID-19 spelled out in the CARES Act (page 86), to clear up any confusion, the Centers for Medicare and Medicaid issued several questions and answers about test coverage.

One Q & A says the plan or issuer should cover the cost of a facility fee if it relates to testing or evaluating for COVID.

When Burke's daughters head back to school in the fall, if they get sick, there's always that chance they may need another COVID-19 test. Burke might need one too.

"Does it make you hesitant to get future COVID-19 tests?" the I-Team's Kristin Byrne asked Burke.

"I mean I think it's our responsibility to get in terms of whether we're sick or not how it impacts other people. So, no I will continue to get covid tests but at the same time, there's going to be a reluctance of 'Hey, am I going to have a bill after this visit?'" Burke answered.

When the I-Team contacted ProHealth for comment on this story, a spokesperson said they couldn't assist because of patient privacy.

After reaching out to the insurer, UnitedHealthcare, agents reached out to ProHealth asking the billing records reflect "COVID-related" services, and the claims were reprocessed.

A spokesperson for UnitedHealthcare said, the insurer, "is waiving cost-share for COVID-19 testing, in compliance with state and federal guidelines."

and that, "The family will be reimbursed for the amount paid to the doctor's office. We encourage members to reach out to their insurers if they have questions, particularly if they relate to COVID services, to ensure they are being appropriately covered."

If you end up getting billed for a COVID-19 test, what should you do?

"We tell patients and their families anytime you get any medical bill, but especially with COVID, delay before you pay," said Donovan.

Donovan encourages patients to look for any errors in your EOB or "Explanation of Benefits." It's a document from your health insurance plan explaining what costs it will cover.

Donovan also says instead of going to urgent care or the emergency room for a COVID test, get one at a community testing center. That way, you're likely not going to see any extra charges because those centers are strictly providing testing and no other services.

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