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If, as a US citizen or resident, I had flu-like symptoms and if I was not covered by Medicaid/Medicare and didn't have health insurance, who would be liable for paying for COVID-19 test diagnostics in a US hospital?

I saw an offhand remark about "the cost and people not getting tested as a result", in an online forum. It wasn't even a claim that it was happening, more like a quip that it might happen.

The US healthcare vs Euro/Canadian-style coverage debate has been done to death, but it usually revolves around the problems lack of coverage brings to the people who are ill. This is not what I am asking about.

An epidemic situation however brings a different dynamic: there's a vested interested for everyone else that sick people are identified as such and isolated, it's not just about the being well-being of the patients. To assist in containment, you want to remove as many barriers to early diagnosis as possible.

Is there/could there be some form of emergency funding for at least the tests themselves, at the federal level? One model is for example, the financial arrangements around vaccination programs.

Edit:

the question concerns the procedure for the entire test, i.e. lab services as well as clinic time: seeing a doctor/nurse, taking the tests and getting the results. Nothing more, but also all of what's necessary for a YES/NO answer wrt having COVID-19 or not.

Bryan's answer is great wrt to the kit and lab services themselves, but someone still needs to interview you and take whatever samples are necessary to send off for testing,

Do these arrangements vary by state? Or does the Federal govt, through the CDC, have jurisdiction?

State vs Federal: it seems to me that a Federal-level guidance ought to be faster than waiting for all 50 states to come up with their own programs individually.

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  • anything done by a hospital that's "not covered by Medicaid/Medicare and (for someone who) didn't have health insurance" is paid for by the patient. In certain situations, various public health organizations (think county clinics, planned parenthood, health districts, free clinics, etc) use funding or donations to offer low/no-cost testing to such citizens, but afaik, there's none of those available for covid-19 yet. – dandavis Mar 2 at 21:58
  • Re: your edits...the rest of my answer includes those other costs (which in this case would be included in the hospital bill if hospital staff were doing the testing): as of now, the patient has to pay unless someone simply decides not to bill them. There is no other funding source. I added a bolded statement in case this wasn't clear from the longer text. – Bryan Krause Mar 3 at 1:31
  • @BryanKrause yes, I had already understood that. thing is, I'd like to really differentiate someone who has an ambulance + a quarantine stay from someone who just walks into a clinic/hospital, doesn't need anything else and just gets tested. the minimal case possible, but still needs the interview. are they potentially on the hook for say $500+? that would not be good. not for them, but also certainly not on the larger population who relies on appropriate quarantines. – Italian Philosophers 4 Monica Mar 3 at 2:37
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The CDC covers the cost of testing itself, however, this may not be the only type of cost incurred.


A recent New York Times article presents a case study of exactly the sort of scenario described in the question.

Americans who were living in China and evacuated from Wuhan did not have health insurance in the US and were given a $3,918 bill for care during quarantine, including $2,598 for ambulance transportation. Neither ultimately tested positive.

He did receive a document upon leaving quarantine directing him to contact a government email address with any medical bills. He sent an email on Feb. 24 detailing the charges and asking what would be done.

“My question is why are we being charged for these stays, if they were mandatory and we had no choice in the matter?” Mr. Wucinski wrote in his message.

He has not received a response, he said.

Since then, after being contacted by the Times, the hospital stated the bill was in error:

When contacted by The New York Times, a Rady Children’s Hospital spokesman said the physicians’ bill had been sent in error and that the family would not be held responsible for the charges.

..but it is not clear whether this is a matter of policy or a public relations move by the hospital, nor is it clear how these matters will be handled going forward. It also does not yet resolve the $2600 ambulance bill (of course this is all still pending).

The government can order mandatory quarantines, but as far as who pays:

“There is no uniform practice,” said Lawrence Gostin, a professor of global health law at Georgetown University. “They do have the powers, but they’ve almost never used them in modern times.”

Without some new government intervention, it seems that for now costs will either be charged to patients or simply absorbed by the treating facilities (by not billing).


The American Hospital Association and American Nurses Association on Feb 27, 2020 have asked for the government to fund care related to the epidemic. It seems likely that there will be further political fights over what exactly is done next.


update: As of March 4th, 2020, an agreement was reached in the House on a bill for COVID-2019 funding, which is expected to pass there and later in the Senate. This bill does not address how to deal with care and testing for the uninsured, though it includes state and local funding. It's unclear at this time how those funds could/will be used:

Congress didn't explicitly address how to handle funding for mandatory quarantines or the uninsured. The package would send $950 million in state and local grants, with half of the money due within 30 days. States will receive a minimum of $4 million.

https://www.politico.com/news/2020/03/04/coronavirus-funding-package-121209

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    Americans can be made to pay for their prison-related expenses, especially huge fees for home detention supervision. I can't see why the capitalistic principles would not be applied here, i.e. pay for their own quarantine. – Fizz Mar 3 at 1:23
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    @Fizz because if someone is sued in court they can argue there was never any agreement to pay. A person involuntarily detained has not signed any contract or otherwise consented to their treatment. – Viktor Mar 3 at 1:30
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    @Fizz sounds like one can plausibly argue duress in that circumstance. – Viktor Mar 3 at 1:34
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    There's already outrage that the CDC released someone who then tested positive. So I wound't put it beyond the plausible that the "default quarantine" is going to be in a place farther away from now on. – Fizz Mar 3 at 1:43
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    "the bill was sent in error" - this usually means "we hope that some people will not contest it and so we'll get easy money from them." – vsz Mar 3 at 7:17

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