The costs of COVID tests: Why insurance is charged more than individuals


DENVER (KDVR) — COVID testing is free for many of us however not to your insurance coverage firm. It seems insurance coverage firms are billed at a a lot greater charge than people who pay out-of-pocket for a similar service.

Which may not hassle you when you have insurance coverage since most insurance coverage firms don’t even require a co-pay, which suggests no out of pocket prices however it bothered Scott Fitzgerald.

“As a result of I actually do suppose it’s cash out-of-pocket as a result of I feel that my insurance coverage firm is getting handled unfairly,” mentioned Fitzgerald.

The native actual property agent received examined within the car parking zone of a former Ok-Mart at S. Monaco Parkway and Evans Avenue. The drive-up testing website is operated by an area physician’s clinic referred to as Ladies’s Well being Group, beneath the identify COVID Drive-up.

Fitzgerald was shocked when he noticed his insurance coverage firm CIGNA was billed $787, “I nearly fell out of my chair.”

The medicare reimburse charge for a nasal swab COVID check is a $100 {dollars} however there’s no legislation that caps what a non-public facility can cost an insurance coverage firm.

Insurance coverage firms gained’t pay no matter a facility asks for however typically insurance coverage firms pay greater than a medical facility expenses a non-public paying particular person primarily based upon contracts medical services have agreed to, so as to settle for reimbursement from an insurance coverage firm.

Within the case of Scott Fitzgerald, his $787 invoice was the mixture of 5 separate expenses.

A $277 doctor payment, that’s the workplace go to, in Scott’s case the car parking zone is taken into account a medical workplace. Folks with out insurance coverage pay $95 {dollars} for the doctor payment.

Then Scott’s insurance coverage was charged $150 {dollars} for the antibody check, to see if he had COVID antibodies from a previous an infection. Somebody with out insurance coverage would’ve been charged $45 {dollars} for a similar antibody check.

Then CIGNA insurance coverage was billed $300 for the nasal swab check to see if Scott Fitzgerald had an energetic an infection. An individual with no insurance coverage would’ve been charged $85.

Then COVID drive-up expenses insurance coverage firms $30 for what the payments calls an OB/GYN Price. FOX31 was informed that’s to cowl the prices of dealing with the specimens.

And eventually, COVID drive-up expenses insurance coverage firms a separate $30 lab payment to cowl employees PPE, private safety gear like medical robes and masks.

Personal pay people will not be requested to cowl the final two charges so for a similar service a person can be charged a complete of $225 versus the $787 that CIGNA was billed on behalf of Scott Fitzgerald.

CIGNA negotiated the $787 invoice right down to $397 however that’s nonetheless almost twice what an individual paying out-of-pocket would’ve been requested to pay.

“For those who cost my insurance coverage firm outrageous charges they in flip are going to show round and cross that onto me the buyer and lift my premiums,” mentioned Fitzgerald. 

The commerce group often known as AHIP or “American’s Well being Insurance coverage Plans” has launched a truth sheet that states “worth gouging in COVID-19 testing is a major drawback” particularly in case your insurance coverage is taken into account out of community.

“I simply sort of felt like this firm and this doctor and his companions are taking benefit. I feel they’re being opportunistic,” mentioned Fitzgerald.

However Dr. Steve Volin, who operates the drive-up testing website Scott used, disputes he’s making the most of anybody.

“Up to now we haven’t made any revenue on this enterprise,” mentioned Dr. Volin, who argues he’s growing entry to as many individuals as potential and charging individuals with out insurance coverage the naked minimal to cowl his prices.

“By operating an out of doors drive-up testing website we’re capable of preserve individuals out of the emergency room and subsequently we really feel we’re decreasing well being care prices,” defined Dr. Volin.

He mentioned he’s not gouging insurance coverage firms however charging them extra as a result of insurance coverage firms take 60 to 90 days to reimburse claims and reimbursement charges differ.

“There’s a major quantity as a lot as 20% that by no means receives a commission in any respect. Claims that get filed with sure sorts of insurance coverage firms reimburse at such a low stage that it prices rather more than what we really obtain,” mentioned Dr. Volin, who added, “We made it a coverage to by no means go after individuals for balances.”

To some extent, Volin acknowledges insurance coverage firms assist subsidize the value for individuals who don’t have insurance coverage to allow them to pay much less for a similar service.

“There’s all the time unscrupulous individuals on the market however we’re a mission primarily based group and I hope individuals will discover that the payments and outcomes meet their wants and folks don’t contemplate it unfair,” mentioned Volin.

Dr. Volin mentioned he works with in-state labs to make sure his sufferers get sooner COVID outcomes, normally in a day or two after taking the check.

The state of Colorado does provide numerous actually free testing websites that gained’t even ask when you have insurance coverage.

 You will discover a location by clicking on this link.   


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