There are still more questions than answers about the costs of coronavirus testing

March 18, 2020, 8:15 PM UTC

As COVID-19 testing is poised to ramp up following the federal government’s recent measures and the rollout of a range of private initiatives, there are still more questions than answers about who will be able to access these tests, who will pay for them or any potential treatment, and how successful these measures will be in deterring the spread of the coronavirus across all parts of American society.

Speaking at the White House press conference on Sunday, Vice President Mike Pence once again stressed that the measures will support all Americans, but offered few details. Last week, he announced that “all the insurance companies” agreed “to waive all copays on coronavirus testing and extend coverage for coronavirus treatment in all of their benefit plans.”

“As we expand testing, we’re so pleased that Congress joined with our administration to make sure that cost is never going to be a barrier to anyone getting a coronavirus test,” Pence said at the briefing. “Now all coronavirus testing is free, and it’s free for every American, including uninsured Americans.”

The full extent of the insurers’ commitment to shoulder the burden of the outbreak, and the level of support from the federal and state level, remains to be seen. 

Blue Cross Blue Shield, Aetna, Cigna, Humana and UnitedHealth Group were among the attendees at the event, according to the White House. So far most insurance companies have committed to waiving co-pays for COVID-19 testing only, not for treatment. Fortune reached out to all insurers named by the White House, and most referred to an online statement or offered comments via e-mail. Cigna did not respond to a request for comment.

For example, Blue Cross Blue Shield’s COVID-19 guidance says coverage “will be consistent with the standard provisions of the member’s health benefits.” 

Some are also covering telemedicine co-pays. “If a commercial member sees a telemedicine provider for their follow-up visit, there are no co-pays as part of our zero co-pay telemedicine offering available for the next 90 days,” according to an e-mailed statement from Aetna.

Even for those with insurance, there are still a lot of details to be worked out.

“Coronavirus doesn’t care if you’re insured, uninsured, Republican, Democrat, black, or white,” said Dena Grayson, a biotechnology executive who was among a group of voices calling for tougher measures since mid-January. “This is not a disease that only hits rich people or insured people. We can see that the number of cases is accelerating, and we’re barely testing.”

For the majority of Americans who have their insurance plans through their employer, a lot of it depends on the new bill and the requirements the federal government will decide to put in place. The House of Representatives passed the Families First Coronavirus Response Act on Saturday, which includes some provisions for testing and financial support for workers. The Senate will be reviewing it this week.

The bill includes establishing “requirements for providing coronavirus diagnostic testing at no cost to consumers, expanding unemployment benefits, and temporarily increasing Medicaid assistance.” While for many the symptoms may be mild, a portion of those infected may require hospitalization, ventilators, and other costs.

“[For] people with insurance but high deductibles, the concern is that those deductibles will be a barrier because they could face hundreds or even thousands of dollars,” said Sabrina Corlette, codirector of the Center on Health Insurance Reforms (CHIR) at Georgetown University’s McCourt School of Public Policy. “The House bill would address those folks by requiring insurers and employers to waive cost-sharing, not just for the tests but for the emergency room visit or an office visit as well.”

The financial uncertainties are potentially even bigger for about 30 million of Americans who are not insured.

The most immediate concern and deterrent for many is access to testing. There is a disconnect between reports of a successful testing rollout from the White House and the experiences of many patients with potential symptoms being turned away because they don’t meet specific criteria, yet may still be carriers and present a health risk to others. 

Nicole Badrinath, a doctoral student at Fielding Graduate University in Santa Barbara, was denied a coronavirus test despite displaying symptoms at Palo Alto Medical Foundation in Fremont, Calif.

“They said they will not test me because I was not high-risk,” Badrinath said. “I was told I was not meeting the requirements like shortness of breath.”

She was denied the test even though she lives with her parents who are in their late eighties.

“I was told to wear the mask at home and to stay away from them,” she said, frustrated and giving up on the idea of getting a test. “That’s fantastic. I’ve been at home with them for the last week.”

At the doctor’s office, she was told to come back if she started having breathing issues. 

It’s clear that the White House overstated the speed and scope of testing last week. Trump campaign national spokesperson Kayleigh McEnany said in a tweet on March 12 that “1 million tests have already been distributed, with 4 million distributed by the end of the week,” an assertion that was retweeted by the U.S. President.

According to data published by the CDC as of March 17, a total of 4,255 tests have been run by CDC labs and 27,623 by public health labs.

When comparing the rate of testing per million people, the United States is in the bottom pack of the countries impacted by COVID-19. The U.S. has administered less than half the volume of tests France has, a country with a much smaller population.

Despite limited testing capacity, some high-net-worth patients have been able to access in-home tests as a part of the “house calls” offered by concierge doctors such as David Nazarian, Business Insider reported. Celebrities like Heidi Klum also shared being able to access a test, invoking a reaction on social media about how the “rich and famous” have access to these provisions.

Pence reiterated in Sunday’s press conference that all coronavirus testing will be free, but a lot of the responsibility will likely fall on the states and private companies to enforce.

Several states like Massachusetts, Pennsylvania, and California are moving to mandate waiving co-pays both for COVID-19 testing and treatment.

In a report published by Imperial College London on Monday, researchers estimate COVID-19 could infect 81% of the U.S. population and as many as 2.2 million could die in the U.S. alone if severe, immediate measures are not taken to mitigate the epidemic. The volume of calls to nurses and call centers is surging across the country.

“We’re definitely concerned,” said registered nurse Jason Phillips, who has witnessed the tripling of his daily volume of calls over the past few days. A lot of people are calling in for basic information, he noted, as well as how and where to get tested.

“There were many people I feel should have been tested right away to help the public health effort in Southern California, but our hands were tied,” said Phillips. “The best we could do was to set up the patients with a telephone appointment and to ask them to self-quarantine until receiving instruction from a provider.” 

He is also concerned about the shortages of basic protective equipment and masks. 

“We’re going to lose whole groups of health care workers due to illnesses and quarantines during this initial wave of community infections,” Phillips said.

Who will carry the bulk of the costs of the COVID-19 outbreak might also depend on how effective current measures are, an analysis of the insurance companies last week by S&P suggested.

“Most insured individuals, especially in group or employer plans, don’t meet their deductible limits until later in the year,” S&P analysts wrote in a report published March 12. “So if the spread of COVID-19 is limited to the first half of the year, the insured will bear a greater proportion of treatment costs. However, if COVID-19 continues to spread later in the year, when insured individuals have met their cost-sharing requirements, the insurer will bear more of the medical costs directly.”

While some communities and other countries are moving to address potential financial hardships and even bankruptcies that may result from the outbreak, the details on health care provisions for workers without health insurance remain very limited.

There are other health care experts who are urging the federal government to expand federal provisions and ease Medicaid enrollment by taking measures like “creating a one-page application form and keeping people continuously enrolled without the need for constant recertification” or allowing “states to temporarily increase Medicaid eligibility higher up the income scale in all states beyond their current income limits.”

Until then, a lot of people from the most vulnerable and most exposed sectors, such as food-service workers, may be the least likely to get tested.

“If you don’t have insurance—either you can’t afford insurance or you’re not working—if you did go to get tested, you’re going to have a tough time getting a test that’s free, because the capacity is so low,” Grayson noted. “Then you get stiffed for a bill that’s a couple thousand bucks, and you can’t go back to work if you’ve tested positive. So why would you get tested? You wouldn’t, there is no incentive.”

More coronavirus coverage from Fortune:

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—How hackers are exploiting the coronavirus—and how to protect yourself
—The coronavirus pandemic could mark a huge shift for the fitness industry
—Listen to Leadership Next, a Fortune podcast examining the evolving role of CEOs
—WATCH: The race is on to create a coronavirus antiviral drug and vaccine

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