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Demand for COVID-19 testing in California and across the country is surging as the highly infectious delta variant spreads and proof of a negative test is increasingly being required for travel, admission to entertainment events, job sites and schools.Testing should be free for individuals with few exceptions at COVID-19 testing sites licensed in California. Health insurance companies are supposed to cover the tests for their members, and the government pays for those who are uninsured. That may not always be apparent if you’re searching online for “COVID test near me” or “rapid COVID test near me.” Some testing sites may claim that one type of test, a PCR, is free while they charge for a rapid antigen test, for example. What about when you’re asymptomatic, getting tested before going on a trip, or because your work requires it? KCRA 3 reached out to several California state and local agencies, major health insurance companies and Covered California to get the facts. Here’s what you should know to ensure that getting tested for COVID-19 to help keep yourself and the community safe doesn’t burn a hole in your wallet. And if you think you have been wrongly charged for a test, there are steps you can take to get reimbursed or file a complaint with the government. You don’t need to have COVID-19 symptoms or a known exposure to get tested for free Federal guidance on Feb. 26, 2021, was a game-changer for making testing free for more people. The guidance said that health plans must cover COVID-19 diagnostic testing for their enrollees by any provider without “cost sharing.”That includes tests when you’re asymptomatic. Health plans and issuers “cannot require the presence of symptoms or a recent known or suspected exposure, or otherwise impose medical screening criteria on coverage of tests,” the guidance says. California’s Department of Managed Health Care (DMHC), which oversees health plans in the state, put together a fact sheet for people to “know your health care rights.”Its main takeaway: you can get a COVID-19 test from any provider at any time and should not pay anything, including a co-pay or payment toward a deductible for getting tested. There is no distinction on whether someone is an essential worker and no limit on the number of times someone gets tested. Were you charged for a COVID-19 test? Had trouble getting reimbursed? Let us know. Email kcrainvestigates@kcra.com.Health plans should give individuals the benefit of the doubt and cover the test — even for travelFrom the federal guidance: “When an individual seeks and receives a COVID-19 diagnostic test from a licensed or authorized health care provider, or when a licensed or authorized health care provider refers an individual for a COVID-19 diagnostic test, plans and issuers generally must assume that the receipt of the test reflects an ‘individualized clinical assessment’ and the test should be covered without cost sharing, prior authorization, or other medical management requirements.”Rachel Arrezola, a spokesperson for DMHC, pointed to the term “individualized clinical assessment” as important. As long as the test was done as an “individualized clinical assessment” it should be covered even if it was done for travel or admittance to an entertainment venue, she said. At least one health insurance company, UnitedHealthcare, says on its website that its plans generally do not cover testing used for “social purposes” like education, travel or entertainment. Arrezola told KCRA 3: “We will be following up with United to clarify the plan’s position and ensure they are covering COVID-19 diagnostic tests when it is for an ‘individualized clinical assessment.'”When told about the state taking issue with their policy as described on their website, UnitedHealthcare spokesperson Tracey Lempner sent this response: “We continue to cover, at no cost-share to our members, testing for the diagnosis of COVID-19 during the national public health emergency period in alignment with applicable law, including the requirements of the CARES Act, and we encourage anyone who has questions regarding COVID-19 testing to contact us for more information.”Coverage of testing for employment purposes is ‘not straightforward’If you’re on a Covered California health insurance plan, COVID-19 test fees are waived for all purposes, according to spokesperson James Scullary. That’s pretty clear.But it’s trickier for private insurance. According to Arrezola with DMHC, the federal guidance on whether a plan can deny coverage for workplace “health and safety” is not “straightforward.”Many private health plans said that group testing as part of a return to work effort is not covered. Cigna told KCRA 3 that “when an employer, school system, or other entity requires repeatable or mass testing for surveillance or employment purposes” that’s generally not covered. UnitedHealthcare also lumps in “return to workplace” as part of what it calls “surveillance testing.”Blue Shield says group testing isn’t covered “unless ordered for each individual by an authorized healthcare provider.” Kaiser Permanente’s website said that testing is free for its members and does not spell out categories when it might not be covered. “To date, Kaiser Permanente has reimbursed medically necessary COVID-19 testing and will continue to work with our members,” Kaiser said in a statement. Here’s what’s going on. The February federal guidance says that health plans “are not required to provide coverage of testing such as for public health surveillance or employment purposes.”But the guidance also says there is “no prohibition or limitation on plans and issuers providing coverage for such tests.” And Arrezola with DMHC says the guidance about an individual getting testing as part of an “individualized clinical assessment” also applies.So what does all of this mean? If a plan were to deny your test, the health insurer “must have a specific reason for believing the testing was done for public health surveillance or employment purposes rather than as an ‘individualized clinical assessment,'” Arrezola said. “The mere fact that testing was performed at a school or employment location will likely not be sufficient to overcome the assumption that the testing was an ‘individualized clinical assessment.'” Arrezola said after KCRA 3’s inquiries about what is covered that DMHC will “remind health plans of the federal guidance and APL (DMHC’s All Plan Letter) including the requirements on the health plans to cover COVID-19 tests.”If your health insurance doesn’t cover the test, your employer mightAccording to the California Department of Industrial Relations, which works with employers to comply with labor laws, if an employer “expressly requires” a worker to get tested or if the test is “effectively required for a job,” then the employer must pay for it. The employer may be responsible for travel costs too, the DIR’s website also says. KCRA 3 has reached out to DIR to confirm this is their latest guidance. Free community-based COVID-19 testing sites are a good option to avoid insurance headachesOne way to avoid a possible entanglement with your health insurer over a fee is to get tested at a community-based testing site. For example, Sacramento County runs 13 testing sites that offer PCR or rapid antigen tests and the county also has a partnership with Curative for testing at Cal Expo. “At all of our community testing sites, you don’t need to have a reason for coming,” Public Health Planner Liz Gomez said last week. That can include testing for people who may be doing so for travel or employment reasons.Something to keep in mind is that your travel destination may only accept tests from certain providers, so travelers should check with the destination for those requirements, county spokesperson Samantha Mott said. Another issue is if a test is required for surgery. Providers usually order those tests in-house or have a specific provider they use, she said. If you’re looking for a community-based test site, check your county’s COVID-19 website or click here to find approved testing sites across California. I was charged for a COVID-19 test and think I should get reimbursed. What should I do? If you’re insured and have a bill, first reach out to your health plan and include a copy of it. If you do not agree with your plan’s response, or if the plan takes more than 30 days to fix your problem, you can file a complaint with the DMHC Help center here or by calling 1-888-466-2219.Here is where you can find COVID-19 testing and reimbursement information for major insurers in California: UnitedHealthcareCignaBlue ShieldKaiserAre at-home COVID tests covered by insurance? In some cases, yes. At-home COVID-19 tests must be covered by insurance when the test has been ordered by a health care provider, according to previous federal guidance. If you’re buying an over-the-counter test, that may not be covered. But you could likely use money from a health savings account or flexible spending account to pay for it. Check with your provider to be sure. | MORE | What to know about different COVID-19 testsWhat to do if you’re uninsured and receive a bill for a COVID-19 test or you already paid a bill? The federal Health Resources and Services Administration says that everyone without health insurance is still eligible for free COVID-19 testing regardless of immigration status. If you receive a bill for COVID-19 testing or treatment, you can tell the provider to send it to the “HRSA COVID-19 Uninsured Program.”If you already paid the bill, you may be entitled to a refund. If the provider doesn’t cancel the bill or pay you back, you can file a complaint here or call 1-800-HHS-TIPS.
Demand for COVID-19 testing in California and across the country is surging as the highly infectious delta variant spreads and proof of a negative test is increasingly being required for travel, admission to entertainment events, job sites and schools.
Testing should be free for individuals with few exceptions at COVID-19 testing sites licensed in California. Health insurance companies are supposed to cover the tests for their members, and the government pays for those who are uninsured.
That may not always be apparent if you’re searching online for “COVID test near me” or “rapid COVID test near me.” Some testing sites may claim that one type of test, a PCR, is free while they charge for a rapid antigen test, for example. What about when you’re asymptomatic, getting tested before going on a trip, or because your work requires it?
KCRA 3 reached out to several California state and local agencies, major health insurance companies and Covered California to get the facts. Here’s what you should know to ensure that getting tested for COVID-19 to help keep yourself and the community safe doesn’t burn a hole in your wallet. And if you think you have been wrongly charged for a test, there are steps you can take to get reimbursed or file a complaint with the government.
You don’t need to have COVID-19 symptoms or a known exposure to get tested for free
Federal guidance on Feb. 26, 2021, was a game-changer for making testing free for more people. The guidance said that health plans must cover COVID-19 diagnostic testing for their enrollees by any provider without “cost sharing.”
That includes tests when you’re asymptomatic. Health plans and issuers “cannot require the presence of symptoms or a recent known or suspected exposure, or otherwise impose medical screening criteria on coverage of tests,” the guidance says.
California’s Department of Managed Health Care (DMHC), which oversees health plans in the state, put together a fact sheet for people to “know your health care rights.”
Its main takeaway: you can get a COVID-19 test from any provider at any time and should not pay anything, including a co-pay or payment toward a deductible for getting tested.
There is no distinction on whether someone is an essential worker and no limit on the number of times someone gets tested.
Were you charged for a COVID-19 test? Had trouble getting reimbursed? Let us know. Email kcrainvestigates@kcra.com.
Health plans should give individuals the benefit of the doubt and cover the test — even for travel
From the federal guidance: “When an individual seeks and receives a COVID-19 diagnostic test from a licensed or authorized health care provider, or when a licensed or authorized health care provider refers an individual for a COVID-19 diagnostic test, plans and issuers generally must assume that the receipt of the test reflects an ‘individualized clinical assessment’ and the test should be covered without cost sharing, prior authorization, or other medical management requirements.”
Rachel Arrezola, a spokesperson for DMHC, pointed to the term “individualized clinical assessment” as important.
As long as the test was done as an “individualized clinical assessment” it should be covered even if it was done for travel or admittance to an entertainment venue, she said.
At least one health insurance company, UnitedHealthcare, says on its website that its plans generally do not cover testing used for “social purposes” like education, travel or entertainment.
Arrezola told KCRA 3: “We will be following up with United to clarify the plan’s position and ensure they are covering COVID-19 diagnostic tests when it is for an ‘individualized clinical assessment.'”
When told about the state taking issue with their policy as described on their website, UnitedHealthcare spokesperson Tracey Lempner sent this response: “We continue to cover, at no cost-share to our members, testing for the diagnosis of COVID-19 during the national public health emergency period in alignment with applicable law, including the requirements of the CARES Act, and we encourage anyone who has questions regarding COVID-19 testing to contact us for more information.”
Coverage of testing for employment purposes is ‘not straightforward’
If you’re on a Covered California health insurance plan, COVID-19 test fees are waived for all purposes, according to spokesperson James Scullary. That’s pretty clear.
But it’s trickier for private insurance. According to Arrezola with DMHC, the federal guidance on whether a plan can deny coverage for workplace “health and safety” is not “straightforward.”
Many private health plans said that group testing as part of a return to work effort is not covered.
Cigna told KCRA 3 that “when an employer, school system, or other entity requires repeatable or mass testing for surveillance or employment purposes” that’s generally not covered.
UnitedHealthcare also lumps in “return to workplace” as part of what it calls “surveillance testing.”
Blue Shield says group testing isn’t covered “unless ordered for each individual by an authorized healthcare provider.”
Kaiser Permanente’s website said that testing is free for its members and does not spell out categories when it might not be covered.
“To date, Kaiser Permanente has reimbursed medically necessary COVID-19 testing and will continue to work with our members,” Kaiser said in a statement.
Here’s what’s going on.
The February federal guidance says that health plans “are not required to provide coverage of testing such as for public health surveillance or employment purposes.”
But the guidance also says there is “no prohibition or limitation on plans and issuers providing coverage for such tests.” And Arrezola with DMHC says the guidance about an individual getting testing as part of an “individualized clinical assessment” also applies.
So what does all of this mean?
If a plan were to deny your test, the health insurer “must have a specific reason for believing the testing was done for public health surveillance or employment purposes rather than as an ‘individualized clinical assessment,'” Arrezola said. “The mere fact that testing was performed at a school or employment location will likely not be sufficient to overcome the assumption that the testing was an ‘individualized clinical assessment.'”
Arrezola said after KCRA 3’s inquiries about what is covered that DMHC will “remind health plans of the federal guidance and APL (DMHC’s All Plan Letter) including the requirements on the health plans to cover COVID-19 tests.”
If your health insurance doesn’t cover the test, your employer might
According to the California Department of Industrial Relations, which works with employers to comply with labor laws, if an employer “expressly requires” a worker to get tested or if the test is “effectively required for a job,” then the employer must pay for it. The employer may be responsible for travel costs too, the DIR’s website also says. KCRA 3 has reached out to DIR to confirm this is their latest guidance.
Free community-based COVID-19 testing sites are a good option to avoid insurance headaches
One way to avoid a possible entanglement with your health insurer over a fee is to get tested at a community-based testing site.
For example, Sacramento County runs 13 testing sites that offer PCR or rapid antigen tests and the county also has a partnership with Curative for testing at Cal Expo.
“At all of our community testing sites, you don’t need to have a reason for coming,” Public Health Planner Liz Gomez said last week.
That can include testing for people who may be doing so for travel or employment reasons.
Something to keep in mind is that your travel destination may only accept tests from certain providers, so travelers should check with the destination for those requirements, county spokesperson Samantha Mott said.
Another issue is if a test is required for surgery. Providers usually order those tests in-house or have a specific provider they use, she said.
If you’re looking for a community-based test site, check your county’s COVID-19 website or click here to find approved testing sites across California.
I was charged for a COVID-19 test and think I should get reimbursed. What should I do?
If you’re insured and have a bill, first reach out to your health plan and include a copy of it. If you do not agree with your plan’s response, or if the plan takes more than 30 days to fix your problem, you can file a complaint with the DMHC Help center here or by calling 1-888-466-2219.
Here is where you can find COVID-19 testing and reimbursement information for major insurers in California:
Are at-home COVID tests covered by insurance?
In some cases, yes. At-home COVID-19 tests must be covered by insurance when the test has been ordered by a health care provider, according to previous federal guidance.
If you’re buying an over-the-counter test, that may not be covered. But you could likely use money from a health savings account or flexible spending account to pay for it. Check with your provider to be sure.
| MORE | What to know about different COVID-19 tests
What to do if you’re uninsured and receive a bill for a COVID-19 test or you already paid a bill?
The federal Health Resources and Services Administration says that everyone without health insurance is still eligible for free COVID-19 testing regardless of immigration status.
If you receive a bill for COVID-19 testing or treatment, you can tell the provider to send it to the “HRSA COVID-19 Uninsured Program.”
If you already paid the bill, you may be entitled to a refund. If the provider doesn’t cancel the bill or pay you back, you can file a complaint here or call 1-800-HHS-TIPS.
