Updated: 11:56 a.m.

For weeks, Minnesotans have heard from Gov. Tim Walz and high-ranking public health officials that getting tested for coronavirus should come at no cost.

But on the ground, that's not always how it's working out.

Hillary Rausch, of Rosemount, heard public health officials say that anyone who participated in mass gatherings surrounding George Floyd’s death should get tested for COVID-19.

So, after volunteering to bring donations to neighborhoods affected by the protests, Rausch found a Burnsville clinic in her insurance network where she could get tested — but she had to pay $75 online before coming in.

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“There was no option to submit insurance,” she said. “It was, ‘If you’re coming here, you’re paying $75.’”

Rausch filed a claim with her insurer, Blue Cross Blue Shield, and is waiting to hear if she will be reimbursed. Minnesota’s insurance plans committed to waiving costs for testing and associated visits.

But as guidance around who can get tested changes, it appears some people are being billed for their tests — or being told they will be billed, which has the potential to put a chilling effect on the state’s efforts to get an accurate picture of the pandemic.

Rausch, a teacher, worries that not everyone has the means to pay those charges — or has the time to fight them.

“I’m very lucky right now I have the summer off. I’m able to look things up on my computer. I have $75 at my disposal,” she said. “Those are privileges I have right now. Not everyone can afford that or have that at their disposal.”

Minnesota Department of Health policy director Diane Rydrych said the state has done a lot to make sure that cost isn’t a barrier to testing.

“Our health system is complicated, and we have hundreds of providers and a lot of different insurers, and we're trying to get everyone moving in that direction so that financial barriers don't get in the way of someone who needs a test getting one,” she said. “When that happens — however that happens — it is a concern for us."

Here’s what you need to know about avoiding costs associated with testing, and how to get them covered if you’re billed.

Should you be charged for a COVID-19 test?

No. You shouldn’t be charged for a COVID-19 diagnostic test.

Federal law requires tests and any associated office-visit cost to be covered by insurance companies without what’s called cost-sharing.

In plain English, that means it shouldn't cost you anything. Minnesota's private health insurance companies have committed to these rules indefinitely.

If you get your insurance through Medicare or Medicaid, you shouldn't be charged, either.

To avoid charges, you need a doctor's referral for the test — and it needs to be in your insurance company’s network.

Meanwhile the state periodically opens pop-up testing sites around the state that bypass insurance all together. The tests there are free and covered by the state.

Who can get a test at no cost?

Coverage for COVID-19 testing is predicated on state guidance around who should be tested. That's what doctors are following as they decide who should be referred for a test.

Early in the pandemic, testing was limited to only certain people — hospital patients, people in congregate care settings and health care workers — because supplies and testing capacity were limited.

But as the state has expanded its testing capacity, it's also expanded the pool of people who qualify to be tested.

As of today, people with COVID-19 symptoms can be tested, and so can people who are asymptomatic — if they’ve had a known exposure to the virus.

Determining whether someone has had a known exposure can be difficult for some providers to determine, said Rydrych.

"It's a bit more of a trust exercise, that if someone goes in and stipulates that they are a contact of a positive person,” she said. “We don't have a mechanism to generate confirmation for everyone."

However, if testing resources are limited, providers can prioritize people who are at the highest risk of spreading the virus or experiencing severe symptoms — which means that it’s possible someone who is asymptomatic but thinks they’ve been exposed to the virus might not get tested on a given day.

If testing is free, why did I get a bill?

According to insurers, the state Health Department and the state Commerce Department, which regulates insurance companies, a few things might be causing patients to get bills for COVID-19 testing.

First, the guidance around who can get a test has changed over the months, and sometimes providers aren't up-to-date on who the state recommends get tested.

In early June, when state officials said people participating in large gatherings around George Floyd’s death could get tested even if they had no symptoms, it’s not clear that all providers were immediately following that guidance.

For instance, HealthPartners said that because the rules around who should be tested are changing rapidly, some people may be charged inadvertently.

In Rausch’s case, it’s possible the provider charged for the appointment. The Health Department said that's not in the spirit of the federal rules around billing for this testing, though there’s no good regulatory mechanism for preventing that.

For its part, Blue Cross Blue Shield, Rauch’s insurer, said it is encouraging providers in its network to make sure patients know they can get a free test if it is ordered by a doctor.

How can I dispute a bill?

All of Minnesota’s insurers said that if your test is ordered by a physician, you should not be charged. That includes people who are Medicare, Medicaid or MinnesotaCare.

But if you are charged, they say you should first dispute the charge through their billing departments.

You can also file a complaint with the Minnesota Department of Commerce at 651-539-1600 or email the department at consumer.protection@state.mn.us.

Correction (July 8, 2020): An earlier version of this story incorrectly included an end date to Minnesota health insurance companies’ commitment to waiving patient fees for COVID-19 testing. The story has been updated.

Some COVID-19 tests come with a bill. Here’s how to avoid one

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