Wheel of Misfortune: COVID Test Prices and Accuracy Are the Worst Guessing Game

In theory, most people shouldn’t be subject to any COVID testing charges...In practice, however, this is often not the case. As with everything else healthcare related, COVID testing and pricing can be tricky.

Stop me if you’ve heard this one before. “In these uncertain times, we are now, more than ever, dedicated to the health, safety, and well-being of our clients / employees / customers.” We’re several months in, but even a few weeks after coronavirus hit the US, all public messaging felt like an echo chamber repeating the same three or four sentences. There’s even a YouTube video compilation of COVID-related ads called “Every Covid-19 Commercial is Exactly the Same”.[1]

The market’s uniformity in COVID-related advertising contrasts sharply with the reality most Americans are facing, not only in individual attitudes regarding the virus, but even COVID testing price and efficacy vary widely. In theory, most people shouldn’t be subject to any COVID testing charges per the Families First Coronavirus Response Act (FFCRA), including out-of-network testing per the Coronavirus Aid, Relief, and Economic Security (CARES) Act. In practice, however, this is often not the case. As with everything else healthcare related, COVID testing and pricing can be tricky. For example, Jimmy Harvey and Pam LeBlanc spoke to The New York Times’ The Upshot on their very different testing costs; both were tested at the same location in Texas, but while Harvey was charged $199 in cash, LeBlanc went through her insurance and was charged $6,408, 32 times the amount of Harvey’s bill.[2] Angie Meoli, a senior VP at Aetna, acknowledged this wide disparity is just as absurd from the perspective of the insurer. “We’ve seen a small number of laboratories that are charging egregious prices for Covid-19 tests,” she said, in a separate interview with The Upshot.[3]

So how do employees figure out how much a COVID test might cost them, and how do plan sponsors help them find that information? While the best approach varies from individual to individual, there are a couple of important questions that determine coverage. First, it can be situationally dependent. Why is a test being requested, and by whom? If an employee believes they may be infected, a doctor’s visit may be necessary for testing to be covered. This may involve additional tests ordered by a physician to eliminate the option of other infectious diseases with similar symptoms (think the flu, strep, etc.) which, depending on the provider and plan, may not covered and could incur additional charges; similarly, a doctor’s visit may be covered, but when a test sample is sent to a lab, the lab work may not be. Additionally, some insurance providers like Aetna will fully cover the costs of “medically necessary” or physician-ordered FDA-authorized tests, but not those required by employers to return to work or school.[4] Consulting the insurance provider’s website is the best way for employees to make sure they’re getting the correct information for them. For plan sponsors, educational resources on HSA coverage and plan details can help employees learn what is covered, what additional questions they need to be asking, and to whom they should be directed.

Secondly, testing location matters; there is no government-mandated price standardization, so costs vary widely across the country. if local testing sites are charging outrageous prices, it may be worthwhile for employees to look outside of their neighborhood where testing fees may be significantly reduced, and some areas provide free testing as local and state governments pick up the bill.

Lastly: keep in mind that not all tests are created equal. When paying for a test, regardless of how much it costs, patients want it to be accurate for the sake of themselves and others (not to mention that being charged thousands of dollars for the wrong results just adds insult to already-overwhelming injury). Plan sponsors may want to provide dashboard notices regarding testing types and methods, their respective accuracy, and provide links to more extensive explanations so employees can make educated choices. For example, the FDA recently issued a warning about the coronavirus test from BD Max Systems, as the BD SARS-CoV-2 Reagents were found to have a 3% rate of false positive results, and the Abbott ID NOW COVID-19 test was found to give false negative results [5] in nearly half (45%) of dry nasal swab cases. [6] Armed with this information, employees can be more discerning in their choice of testing centers.

While some essential medical procedures and other obligations must take place and will necessitate COVID tests, minimizing contact with others is still the best way to avoid potential COVID exposure and the “just-in-case” testing headache that may follow. That means that, even though Disney theme parks are open, it’s best to delay your vacation.[7] As much joy as your kids may find at the House of Mouse, it’s healthier to stay home for now so you don’t have to worry about health risks and the complexities and expenses of either Space Mountain FastPasses or COVID tests.

[1] https://www.youtube.com/watch?v=vM3J9jDoaTA

[2] https://www.nytimes.com/2020/06/29/upshot/coronavirus-tests-unpredictable-prices.html  

[3] https://www.nytimes.com/2020/06/16/upshot/coronavirus-test-cost-varies-widely.html

[4] https://www.aetna.com/health-care-professionals/covid-faq/patient-coverage.html

[5] https://www.fda.gov/medical-devices/letters-health-care-providers/false-positive-results-bd-sars-cov-2-reagents-bd-max-system-letter-clinical-laboratory-staff-and

[6] https://pubmed.ncbi.nlm.nih.gov/32471894/

[7] https://www.marketwatch.com/story/the-beginning-of-a-horror-movie-disney-world-slammed-as-doors-reopen-amid-spiking-coronavirus-cases-2020-07-12

These articles are prepared for general purposes and are not intended to provide advice or encourage specific behavior. Before taking any action, Advisors and Plan Sponsors should consult with their compliance, finance and legal teams.

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