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Testing for coronavirus should be free, but it’s not always that simple

March 3, 2020, 11:35 PM UTC

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If you’re worried you might have COVID-19, how does the coronavirus testing procedure actually work? And how much does it cost? The answer is: It’s complicated, confusing, and a lot of people simply don’t know the intricacies of the situation—including the financial burden a U.S. patient with suspected coronavirus might have to bear.

Fortune reached out to all 51 state public health departments in the country (each state and the District of Columbia), urgent care centers, pharmacy giants, the Centers for Disease Control (CDC), and multiple other agencies to figure out how the process plays out. Most didn’t respond or declined to comment.

Here’s what we know so far.

Why was the U.S. slow to test for coronavirus?

It’s unclear why the CDC and the Trump administration decided to develop their own test instead of using those already in place in countries with major outbreaks. Manufacturing issues for the CDC’s coronavirus test significantly slowed down the process in the U.S.

According to the CDC’s latest numbers, there have been a total of 60 cases of COVID-19 (the official name for disease caused by the new coronavirus strain) in the U.S. and six reported deaths, all of them in Washington state. Those cases now span a dozen states: California, Oregon, Washington, Arizona, Illinois, Wisconsin, Florida, Georgia, New York, New Hampshire, Massachusetts, and Rhode Island, with Georgia and New Hampshire reporting the newest known cases.

That number is expected to swell significantly in the coming weeks and months as the CDC fixes its test and distributes it to state and local labs across the nation.

On Monday, Tom Frieden, former CDC director and former commissioner of New York City’s health department, held a public briefing to discuss the U.S. response to coronavirus to date. Frieden, as many public health officials have done, praised China’s rapid response and containment efforts and pointed to the lessons learned and mistakes made in America’s own quest to quell the pathogen.

“In 2009, with the H1N1 flu epidemic, and with the Ebola outbreak in 2014, the CDC’s labs and contractors created high quality tests very quickly,” he said in response to a question from Fortune during the briefing. “This time there’s clearly been a glitch in that process. I think it’ll be important when things quiet down to have a review and figure out what went wrong.” He went on to emphasize his confidence in the medical professionals at the CDC.

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President Trump appointed Vice President Mike Pence as the leader of the administration’s coronavirus response. On Sunday, Pence said that the CDC’s manufacturing capacity for testing would ramp up significantly by the end of the week, and that state and local laboratories would be able to conduct their own initial testing without having to send samples to a federal CDC lab—a critical tool in containing the outbreak, according to Frieden.

In addition to the CDC test, the Wadsworth Center, a research lab within the New York State Department of Health, developed its own FDA-approved test, the first of its kind. The center partnered with hospitals to expand testing.

Who gets tested for coronavirus?

Fortune reached out to every state health agency in the country to ask about the status of coronavirus testing. Most declined to comment, did not reply, or pointed to a press release. A handful—Wyoming, Wisconsin, Utah, Hawaii, Louisiana, New York, Arkansas, Indiana, and Idaho—directly answered questions either via email or by phone.

The departments Fortune spoke to presented a common narrative: CDC-cleared coronavirus tests are finally making it to state and local labs. The CDC has stated that as many as 40 public health labs across the country can conduct coronavirus testing at the moment.

“In Arkansas, today, our state public health lab is testing,” said Dr. Jennifer Dillaha, medical director for immunization and outbreak response in Arkansas, on Monday. “Today is the first day that we’ve been able to do our own test.”

According to Dillaha, the CDC has provided guidelines to help state agencies make judgments on who to test, but discretion will fall to the individual agencies—although she doesn’t think there will be much variance between public health departments’ procedures.

In Arkansas, assessing that risk relies on a combination of factors including whether or not someone has been to a region where the outbreak is prevalent or had contact with an infected individual. If the U.S. continues to see a “community spread” of coronavirus—the term used when the source of infection is unknown—it’s expected that more people will be tested.

How is coronavirus testing done?

The coronavirus test is a combination of a nasal swab and an oral swab. Dillaha said medical professionals might only take one or the other, but labs prefer to have both.

As of now, urgent care centers and organizations like CVS’s health clinics cannot conduct coronavirus tests on site, according to a CVS spokesperson. That may be a possibility in the future should private commercial entities develop their own coronavirus tests; as of now, samples collected at hospitals, urgent care centers, and doctors’ offices are sent to public health labs cleared to conduct the reviews.

Dillaha says that Arkansas public health labs can conduct the test within four hours. Initial results are shared with medical professionals and patients, and then samples would be sent to a CDC lab for final confirmation.

How much does the coronavirus test cost?

Any coronavirus test conducted in a public health lab using an FDA-approved test should, theoretically, be free to the patient.

“Those people are all tested by the CDC. It’s not based on whether or not someone would be able to pay,” said Dillaha. “Of course no test is free. Someone is bearing the cost.”

She notes there are ongoing conversations between federal and state authorities on how to finance the tests and that she doesn’t know all the intricacies of the payment situation.

Representative from Utah, Wisconsin, and New York’s health departments concurred, saying FDA-approved tests (the CDC test and the Wadsworth Center test) that are tested in public health facilities are free to patients.

But the fragmented nature of the American health system complicates the issue significantly. For instance, even though the coronavirus test itself is free, the associated hospital stay, doctors’ visit, or quarantine may not be—and depending on the quality of one’s insurance, a patient with a suspected case may face thousands of dollars in medical costs. An urgent care visit or hospital stay related to coronavirus may not be fully covered.

New York Governor Andrew Cuomo announced in a tweet on Monday that he had issued a directive “requiring NY health insurers to waive cost sharing associated with testing for #coronavirus, including emergency room, urgent care and office visits.” He added that anybody in the state covered by Medicaid would not have to pay for coronavirus-related care. It’s unclear how this would play out for those with private insurance.

More must-read stories from Fortune:

How to think about COVID-19
—Coronavirus spreads to a previously healthy sector: corporate earnings
Coronavirus is giving China cover to expand its surveillance. What happens next?
—Coronavirus shows why we need vaccines before, not after, an outbreak
—Before coronavirus, there were SARS and MERS. Do epidemics ever really end?

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