The COVID test should be free.Loopholes lead to charges

Free testing was considered a fundamental aspect of America’s response to the COVID-19 pandemic.

NS Family’s first coronavirus response And that Coronavirus Assistance, Relief and Economic Security Act Explicitly state that the patient is not responsible for the cost of testing for the virus.

So why a colleague asked me the other day, after she returned from her recent trip to Florida, his wife had to pay $ 47.50 for her COVID test at a CVS drugstore in Southern California. Did you have to?

The answer highlights the gapped legal holes that allow test fees, even if federal law declares that such fees should not be charged.

It also shows the stupidity of the $ 4 trillion healthcare system, which allows insurers to choose between refundable and non-refundable providers.

“This is a loophole in the COVID test and needs to be fixed soon,” Gerald Kominsky, UCLA’s professor of health policy and management research, told me.

Under federal law, all public and private insurance plans must fully cover the COVID-19 test approved by the Food and Drug Administration. This should mean that there is no out-of-pocket cost for the patient.

However, if the test provider sends the COVID swabs to a lab outside the insurance company’s coverage network, the law does not support refunds.

This is what happened to my colleague’s wife. CVS sent the test to a lab outside the network with which it has a business relationship. The lab charged her insurance company an unexpectedly high inspection fee.

The insurer paid most of the cost and then handed the patient a $ 47.50 claim.

CVS Health states that such fees are neither its responsibility nor the responsibility of the lab used.

Joseph Goode, a spokesman for the pharmacy chain, said:

The insurance industry has known this loophole for months — and claims that these claims are not the fault of the insurer.

and Recent reports The US health insurance plan, an industry group, entitled “Price Gouging in the Public Health Crisis,” states that “healthcare providers have aggressively eliminated patient cost sharing for COVID-19 diagnostic testing and treatment. “.

However, more and more healthcare providers are relying on labs outside the coverage network of major insurers, and many of these facilities cost more than $ 130 within the average network to process COVID tests. He states that he is billing. (The insurer’s actual repayment rate is probably much lower.)

In some cases, the insurance group said labs outside the network are charging nearly $ 400 to process each test.

It called on Congress to “eliminate the ability for price gouging to occur by setting reasonable market-based pricing benchmarks for testing provided by the network.”

Yeah, that’s one way to do it.

another, As I have advocated Abolishing the coverage network throughout the pandemic.

Such networks are nothing more than lovers’ transactions aimed at saving large amounts of cash to insurers in return for directing policyholders to specific healthcare providers.

Such networks help keep medical costs down, but they are not the only way.

Most other developed countries instead rely on single payer insurance systems to negotiate flat rates. all The provider allows you to treat your patients wherever you want for the same cost.

Such systems are responsible for providing the best possible service at the best possible price if a commercial insurer wants to win people’s business, rather than dictating the conditions that are most useful to their interests. I will blame the hospital.

And don’t overlook how the insurance industry has responded to this loophole in the COVID test. It requires lawmakers to impose a “market-based pricing benchmark for testing.”

In other words, it is the upper limit of the price.

Whenever patients and their supporters demanded a medical cost cap in the past, various corporate players such as doctors, hospitals, pharmaceuticals and insurance companies grabbed the pearl and plunged into the “socialized medical” outlook. ..

In fact, the United States is one of the few countries that charges as much as possible for healthcare providers to escape and allows private insurers to negotiate individually with each provider.

This is an inefficient and arguably inefficient way to reduce medical costs.According to the Kaiser Family Foundation, medical costs in the United States A total of $ 74.1 billion in 1970..

By 2000, medical costs had reached approximately $ 1.4 trillion. As of 2019, the total has more than doubled to $ 3.8 trillion.The federal government estimates we will spend Over $ 6 trillion Every year by 2028.

It’s very obvious: a healthcare system focused on making as much money as possible for private gain does not change the way. Why? This is a big, big business.

As far as COVID testing is concerned, USC public policy professor Jason Doctor said lawmakers aren’t thinking about the results of COVID test providers using labs outside the insurer’s network.

“Unfortunately, the problem is left to the consumer,” he told me.

My advice in this situation is to stink the insurance company. Some may consider exempting patient fees for COVID testing. This is because the patient is not responsible for any processing outside the network.

If that doesn’t work, consider Make a complaint With the California Insurance Department.

It’s up to lawmakers to quickly modify existing rules to make it clear that people pay nothing regardless of where the test is processed.

But why stop there? What about the standard prices for insulin, epinephrine and other widely used life-saving drugs?

What about standardized prices for visits to emergency rooms, ambulance rides, and other medical services?

Jeffrey Hock, a health economist at the University of California, Davis, called the loophole in the COVID test “an example of what happens when different providers allow different amounts to charge the same service.”

“If you think of healthcare as an airplane seat or a concert ticket, OK, let the market charge the market,” he told me.

But if the goal of health care is to reflect “our commitment to people in need,” the medical industry “considers the impact of their business practices and how to do good by doing good.” You may want to find it, “Hock said.

That’s a good feeling. But I’m not holding my breath.

The loopholes in this test once again prove that companies will not hesitate to unscrew patients if they can make money from healthcare.

That’s the American way. And that’s why Americans pay more for treatment than anyone else.