Article 43


Tuesday, October 13, 2020

The Price of a Caronavirus Test

image: caronavirus

Back in March 2020, CDC DIRECTOR ROBERT REDFIELD went on record saying the goverment will pay for testing and treatment of coronavirus regardless of insurance coverage.

Watch him speak his empty words HERE:

image: cdc director redfield

Here’s the LAW Representative PORTER pointed out that gives him the power:

The Director may authorize payment for the care and treatment of individuals subject to medical examination, quarantine, isolation, and conditional release

In the time that’s passed since, I haven’t been - and probably won’t be - tested.

I splurged for a mask to wear in public to help protect others, but if the disease winds up in my body, I hope it isn’t painful, and kills me quick, cause I can’t afford to get it fixed.




Q&A: How much does it cost to get a COVID-19 test? It depends.

Josh Sharfstein, professor of practice and vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health, on the nuances of insurance coverage and expenses that accompany COVID-19 testing.

Widespread testing for the novel coronavirus has proven an essential tool in fighting the spread of the disease. Testing allows public health officials to track the viruss path, understand disease prevalence, and determine the need for isolation and quarantine. As the demand for COVID-19 testing has grown, so too have questions about who bears the cost. To understand more about the nuances of insurance coverage and expenses that accompany COVID-19 testing, we reached out to Josh Sharfstein, Professor of Practice and Vice Dean for Public Health Practice and Community Engagement at the Johns Hopkins Bloomberg School of Public Health.

How much does a viral test for COVID-19 cost?

There is a wide range in charges. An investigation by the Kaiser Family Foundation determined that the cost of a test can range anywhere from $20 to $850, with $127 being the median cost. Currently, the Medicare reimbursement rate for a COVID-19 test is either $51 or $100, depending on the type of test offered. For those who end up paying out of pocket, there was a smaller range of $36 to $180 per test. Again, any test would also likely require additional charges for specimen collection and a physician’s visit, which could potentially add to the cost significantly.

Does the cost vary depending on where you live?

Yes, in part. The cost for a COVID-19 test may vary a great deal based on type of laboratory where the test is processed, region of the country, insurance provider, and other factors. This unpredictability of cost is part of the larger, fragmented healthcare system in the United States that leads to a wide variability in medical expenses.

Does insurance cover the costs of a COVID-19 test?

Federal law requires insurers to cover the costs of COVID-19 tests, but unfortunately patients are still being charged for related expenses. The law does not require insurers to cover the cost of the medical consultation or doctors referral that may be required before a test will be administered. Another reason is that federal guidance only requires reimbursement for “medically appropriate” testing. An insurance provider might decide that certain types of testing (such as testing after a trip) may not be considered “medically appropriate.”

What about the uninsured?

The federal government has provided a path for reimbursement for COVID-related testing and treatment expenses for the uninsured, including testing. Details about this program are available here. There is no requirement that clinics or physicians avail themselves of this program. As a result, it is possible that the uninsured could still be charged for testing by their healthcare provider.

Why is there so much confusion about pricing and payment for COVID-19 tests?

Early on in the pandemic, in March, several faculty members at Johns Hopkins - myself included - recommended a very different approach to the piecemeal strategy adopted by the federal government. The idea would be to build a crisis insurance system centered on paying to test for and treat COVID-19, and to use the existing Medicare infrastructure and network to provide a payment system for all providers. Since the scale of the problem is national, a federal program would have the capacity to negotiate prices on a global scale, which would help reduce costs. It would also provide an easy route for billing among the large influx of requests for tests and materials that are inundating labs, emergency departments, and hospitals. Additionally, centralizing the expenses from coronavirus care under a crisis insurance program would greatly improve our data collection efforts as we continue to track the virus. Such an alternative path would have prevented many of the current frustrations with accessing and paying for diagnosis and care.



COVID Testing Is Supposed to Be Free. So Why Are People Still Getting Huge Bills?

By Kristen Bahler
CNN Money
August 18, 2020

Free, universal coronavirus testing is critical to flattening the arc of infection. But while federal law aims to make such testing EASY TO ACCESS and WIDELY AVAILABLE, those efforts have fallen short for many Americans.

The U.S. healthcare system - chaotic in any normal year - is being stretched tissue-paper thin by a flood of coronavirus cases, and squabbling between insurers and legislators about who should pay for that influx isnt making things easier.

So while President Donald Trump has signed multiple orders designed to ensure Americans can get tested for COVID-19 for free, regardless of their insurance coverage, policy loopholes have left numerous ways for patients to get stuck with a bill anyway. (See: The California essential worker who was charged nearly $2,000 for COVID-19 testing, or the woman in Austin, Texas who got a $6,000 bill, according to NPR and the NEW YORK TIMES, respectively.)

Here’s everything we know about how much coronavirus tests actually cost and why some people are having to pay thousands of dollars out of pocket.

[Note: The type of testing referenced throughout this story refers to the COVID-19 diagnostic test, not the antibody test. A complete guide to the where to buy coronavirus antibody tests and how much they cost CAN BE FOUND HERE].

How much is a COVID-19 test SUPPOSED to cost?

Prices for coronavirus testing aren’t federally regulated, according to a REPORT from The Peterson Center on Healthcare and the Kaiser Family Foundation (Peterson-KFF). Like other types of medical fees, insurance companies have to negotiate the cost with the providers and labs that dole out the tests.

The CARES Act requires hospitals and other medical providers to disclose the CASH PRICE of COVID-19 tests on their websites, which, in theory, could help could people looking to take the test know exactly how much money they’ll be out if they end up having to pay for it on their own. But not all medical providers are following that CARES Act rule - and those that are publicly posting coronavirus test prices are disclosing costs ranging anywhere from $20 to $850 per test, according to the Peterson-KFF report. That’s quite a spectrum, and it doesn’t include fees for other services that may be required, like doctors visit charges, specimen collection, or other types of diagnostic testing.

How to get free COVID testing

Insurers are legally required to pay for in-network testing, so try to find a medical facility where you know you’ll be covered. Many insurers have also agreed to cover the cost of a COVID test if its done at an OUT-OF-NETWORK facility, but you’ll want to reach out to your insurance company (or Medicare/Medicaid provider) before your visit.

As of this writing, the government is REIMBURSING MEDICAL PROVIDORS that give coronavirus tests and treatment to uninsured Americans, as long as certain qualifications are met. So as long as you have a SOCIAL SECURITY NUMBER AND A STATE I.D., you should be able to get a test for free or for a nominal fee - even if you don’t have insurance.

Here’s where it gets tricky. Insurers aren’t required to pay for fees incurred by patients who seek a COVID-19 test but don’t actually GET the test. So if a doctor decides not to test you for the virus, or the facility has run out of tests completely, you could still be on the hook for whatever fees you happen to rack up during your visit from a strep test to a five-night HOSPITAL STAY.

THE RULES for out-of-network coverage are even more muddled, which can be particularly burdensome for people living in rural and low-income pockets of the country where medical providers ARE FEW AND FAR BETWEEN.

“Such charges - can be financially burdensome or prohibitive for uninsured or self-pay patients, especially given the current labor market and high rates of unemployment,” the KFF report says.

Where to get a coronavirus test

Your state and local health department websites should have a list of the hospitals, clinics, and “drive-thru” screening facilities offering COVID-19 tests in your area, according to the CDC.

Many doctors and medical centers are scheduling TELEHEALTH APPOINTMENTS over video prior to administering the test in-person, so make sure you know what the procedure is before trying to get a walk-in appointment (you might get turned away if you just show up). Pharmacies like CVS and WALGREENS are also operating pop-up testing sites appointments for those facilities can be booked online.



How capitalism made the world sick.

By Sarah Jones
The Nation
August 25, 2021

No one should pay for a coronavirus test. This is not a moral judgment but a statement of fact; the US government has decreed it so. Insurers are supposed to cover the tests, at no cost to the consumer. But hospitals recognized an opportunity for profit.</b> The prestigious Lenox Hill Hospital in Manhattan BILLED ONE PATIENT $3,358 for a test in March, The New York Times reported. Northwell Health, the nonprofit that operates the hospital, justified the bill as a necessity: Its emergency room care is simply that good, it claimed. The hospital billed another family $39,314 for 12 tests.

The Lenox Hill bills are shocking not just because they are so high but because they should not exist. They violate a principle that has come to the fore during the pandemic: that the public’s health transcends all other concerns, including the profit margins of hospitals and insurers. The tests should be and are free. The same for the Covid vaccines; in many cases, they are administered by local, state, or federal agencies at sites set up for this purpose for the sole benefit of the public. For now, at least, a world of health care that’s very different from the one were used to is not only possible but exists.

What the pandemic reminds us is that this alternative world has long been possible. Yet we are still mired in A SYSTEM that EXTRACTS PROFITS from people’s health and puts thousands of families and individuals into crippling debt. In their new book, Inflamed, Rupa Marya and Raj Patel chart the HUMAN COSTS of this for-profit health system and look beyond it to what they call “colonial capitalism,” the root system of our moribund world. They also argue for an alternative: a society informed by “deep medicine,” which can heal whats gone so terribly wrong. Comprehensive in scope, Inflamed moves from environmental pollution to debt to misogyny to settler colonialism and empire, arguing that this vast array of maladies are all consequences of capitalism.

“When something upsets our ecosystems, whether it’s pollution or a pandemic, the consequences show up in our bodies,” the authors write. “So: salmon are to rivers as hearts are to blood vessels. They both function as nutrient pumps in systems of circulation.”

Our inflamed condition is ultimately, Marya and Patel argue, a political one. Politics has failed us by not creating a society that seeks to increase the health - physical, emotional, financial - of all its members. As Renee Hsia, a professor of emergency medicine at the University of California, San Francisco, told the Times, Lenox Hills billing practices are what to “expect from a market-oriented approach to health care.” Its the behavior our laws have “incentivized.” If the public is a kind of body, it needs a cure: a politics that can confront and replace our current market-based approach.

To tell their story, Marya and Patel reject the standard military analogies for the immune system. Inflammation, they argue, is a sign that the body is trying to heal itself - fnot so much that it is under attack but that it is ailing from within. While they indulge in this metaphor perhaps a bit too much, they aren’t comparing contemporary life to, say, cancer. Rather, theyre asserting that capitalism forces people to live in a way that causes higher rates of illnesses like cancer - and that alternatives have always existed.

Debt, the authors note, is a tool of the colonizer. It is the means by which European governments accumulated the funds to build their imperial armies and to trap the Indigenous into body-destroying labor and a way to continue to suppress them. In Peru, colonizers adopted the Incas mita system and stamped their own image on it, using it to pay silver miners low wages that kept them indebted. “Mita was debt,” Marya and Patel write, “and debt was death.” Debt provided an early rationale for policing and a way to keep the Indigenous population in servitude. It is unnatural, especially in the context of health care, where it inflicts great stress on those who must go into debt in order to survive. With trade as the global circulatory system, debt becomes “a choke point, a source of stress and thus the cause of biochemical reactions.”

When someone receives a surprise hospital bill, the anticipation of future debt causes a physical as well as a psychological response. The body knows something harmful has occurred. ԓStress is a state of real or perceived threat to homeostasis, the authors write. Without relief, the body remains in that state of stress, activating chemicals and initiating ԓa cycle of alarm that ԓfeeds back on itself. The consequences can be severe: ԓWhen chronic stress is the background noise of life, it impacts our cells, our DNA, and our children.

The planet, Marya and Patel argue, is undergoing a similar process of depletion and destruction. For example, the disappearance of salmon in the Pacific Northwest can upset the regionԒs ecological balance for good. Whats bad for the salmon, and for the Indigenous people who have long relied on them, will eventually be bad for everyone else, creating a chronic background of stress and inflammation in the environment, in the same way that the stress and inflammation of debt hovers in the background of individuals and their families. The salmon are an early warning sign, and so are the human beings who are closest to them.

The extractive nature of colonial capitalism reserves its heaviest burdens for a class that Marya and Patel call the ғimmunes, borrowing a term from the ancient Romans. Because of ԓa legal quirk of the Roman Empire, they tell us, the ԓimmunes lived in ԓnonmunicipal cities under Roman control, exempt from some of the responsibilities of the typical citizen but also deprived of some basic rights under Roman law. The immunes were never quite Romanԗthey were imperial subjects without the privileges of citizenship. Modern immunes, Marya and Patel write, occupy a similar position. Those who live in a society without the full benefits of its rights and protectionssuch as Black Americans and Indigenous peopleחmay find that they have shorter lifespans, a greater likelihood of contracting and dying from Covid, and more illness in general. Immunes know that the time is nigh for fire,Ӕ they write, and itӒs time to get to work.

Puerto Rico provides Marya and Patel with particularly rich material for consideration, because the material damage of colonial capitalism can be found everywhere: ԓWhile Puerto Ricos money matters to its colonists,Ҕ they write, the bodies of the islandӒs inhabitants dont.Ҕ Puerto Ricans live like immunes in their own homeland,Ӕ with the United States wielding tight fiscal control over the [its] debt repayment regimes, through a Financial Oversight and Management Board.Ӕ As a direct result of colonial rule, Puerto Ricans lack reliable medical care, infrastructure, and, often, access to fresh food. In Puerto Ricoindeed, wherever the immunes dwellחtrauma leaves a physical mark as well as an emotional one, a phenomenon that Marya and Patel examine at some length. Discrimination, PTSD and adverse childhood events,Ӕ they observe midway through the book, all set adults up for chronic inflammation, mediated through pathways of stress.Ӕ Yet these experiences can be the basis for something new: Out of the immunes ғcurrent state of emergency, a ԓradically different future might emerge. ԓThe immune is oppressed, the authors argue, but also the potential source of change.

What, then, is the solution? Marya and Patel return frequently in Inflamed to the notion of deep medicine. ԓRather than taking things apart to know (dia-gnosis), they write, ԓdeep medicine puts the pieces back together to understand and to heal whats been divided. It never separates a person or a community҅from the web of relationships that confer sickness or health. It is from that place of understanding that healing actions become possible.

Deep medicine, they add, ԓrequires new cosmologies. Capitalism doesnԒt just take; it severs, breaking the bonds between people and between people and the land. A deep medicine approach can begin to suture these wounds and restore the sufferers to a state of wholeness.

One example they offer: declaring a debt jubilee for poor countries. “Reparations for the historical harms caused by colonial debt are a moral requirement,” they write, as is the need to make public goods of energy, shelter, education, and health care.Ӕ Toward the end of the book, they advocate a global Green New Deal,Ӕ observing: Part of colonialism’s sleight of hand is its normalization of the capitalist political, economic, and ecological framework in which care is practiced. The economic system that allocates care as a good, on the basis of ability to pay, turns something inherently relational into something to be consumed like a hamburger.

A new model is clearly in order. But when it comes to discussing how to create one, Inflamed is short on specifics. No book can be all things, and this one is ultimately a work of diagnosis more than one of prescription. At once empathetic and skeptical of power, it is bold and searching in its examination of the ways in which the human body has exhibited the consequences of a specific economic and political system. Yet Marya and Patel might have reserved more space to consider the kinds of political solutions that will be needed to abolish such a system. The immunes must drive whatever change occurs, but how is another question altogether. Change implies a process, and its shape remains blurry at the end of the book. Perhaps thatԒs a problem no author can solve: Outside fiction, a person must writeabout what exists. A world without colonialism, without capitalism, belongs to the pastand the past is replete with its own horrors. Even so, Marya and Patel argue, the cultures and traditions of those oppressed by colonial capitalism offer us דthe way forward, even if the path isn’t always clear. Settler ideologies have circumscribed the imagination,Ӕ they write. The future is creative work.

As the world plots a course past Covid, we will need new institutions as well as new medical practices and a new way of imaging our place in the world. To get there, we will also need power. A nearly $40,000 hospital bill is a horror at any time, but Covid unveils its true inhumanity to the world. The time for healing is here.


Posted by Elvis on 10/13/20 •
Section Dying America
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