Insurers must pay full cost of COVID-19 testing – and FQHCs must post their fees on public website
Thursday, April 16, 2020
Federal law now requires all health insurers (except short-term plans) to cover all costs associated with COVID-19 testing -- without imposing any copays or deductibles, and regardless of whether the provider is in-network. This requirement covers not only the actual test, but also the visit (whether in-person or via telehealth) that resulted in the order for the test.
As insurers are required to reimburse out-of-network providers for these services, the CARES Act require providers that order and/or provide testing to post the cash price of these services on their public website. This requirement is addressed in FAQ #7 of recently-published Administration guidance on these provisions.
Highlights of this FAQ include (emphasis added):
If the plan or issuer does not have a negotiated rate with such provider, the plan or issuer shall reimburse the provider in an amount that equals the cash price for such service as listed by the provider on a public internet website, or the plan or issuer may negotiate a rate with the provider for less than such cash price.
Section 3202(b) of the CARES Act also requires providers of diagnostic tests for COVID-19 to make public the cash price of a COVID-19 diagnostic test on the provider’s public internet website. Section 3202(b) of the CARES Act also grants the Secretary of HHS authority to impose civil monetary penalties on any provider that does not comply with this requirement and has not completed a corrective action plan, in an amount not to exceed $300 per day that the violation is ongoing. (updated 4/16/20)
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