July 6, 20205:00 AM ET
Fresh off a Caribbean cruise in early March, John Campbell developed a cough and fever of 104 degrees. He went to his primary care physician and got a flu test, which came up negative.
Then things got strange. Campbell says the doctor then turned to him and said, “I’ve called the ER next door, and you need to go there. This is a matter of public health. They’re expecting you.”
It was March 3, and no one had an inkling yet of just how bad the COVID-19 pandemic would become in the United States.
At the JFK Medical Center near his home in Boynton Beach, Fla., staffers met him in protective gear, then ran a battery of tests — including bloodwork, a chest X-ray and an electrocardiogram — before sending him home. Because he had not traveled to China — a leading criterion at the time for coronavirus testing — Campbell was not swabbed for the coronavirus.
When John Campbell developed his first symptoms in early March of what turned out to be COVID-19, doctors didn’t give him a confirmatory swab test because he hadn’t traveled to China. Because of a loophole in federal rules, that meant his insurer didn’t have to cover the diagnostic exams and tests he underwent in the ER at the time.John Campbell
A $2,777 bill for the emergency room visit came the next month.
Now Campbell, 52, is among those who say they were wrongly billed for the costs associated with seeking a COVID-19 diagnosis.
Why insurers aren’t paying
While most insurers have promised to cover the costs of testing and related services — and Congress passed legislation in mid-March enshrining that requirement — there’s a catch. The law requires the waiver of patient cost-sharing only when a coronavirus test is ordered or administered.
And therein lies the problem. In the early weeks of the pandemic and through mid-April in many places, testing was often limited to those with specific symptoms or situations, likely excluding thousands of people who had milder cases of the virus or had not traveled overseas.
“They do pay for the test, but I didn’t have the test,” says Campbell, who appealed the bill to his insurer, Florida Blue. More on how that turned out later.
“These loopholes exist,” says Wendell Potter, a former insurance industry executive who is now an industry critic. “We’re just relying on these companies to act in good faith.”
Exacerbating the problem, many of these patients were directed to go to hospital emergency departments — the most expensive place to get care — which can result in huge bills for patients.
Insurers say they fully cover costs when patients are tested for the coronavirus, but what happens with enrollees who sought a test — but were not given one — is less clear.