Despite repeated assurances that testing for coronavirus disease is available to everyone for free, people will still encounter bills at some South Carolina testing locations.
That's because no law requires testers to bill insurance or government aid programs.
A search by the newspaper found prices ranging from $0 to $300. The upshot: Some South Carolinians are paying for COVID-19 testing when many free options exist.
The greatest share of nasal swabs are taken by the S.C. Department of Health and Environmental Control and the Medical University of South Carolina.
But some smaller labs and clinics are offering fast tests to those willing to pay a premium, capitalizing on people's need for quick answers to what's ailing them during a pandemic.
Karen Pollitz, a senior fellow at the national health policy nonprofit the Kaiser Family Foundation, said the CARES Act passed by Congress in March required all health insurance companies to cover the full cost of a COVID-19 test. That means no out-of-pocket costs at all. The CARES Act also enabled a program that reimburses testers for patients who don't have insurance.
But the CARES Act did not require clinics and labs collecting the tests to actually bill insurance companies or apply for compensation from the federal government. So if the provider doesn't want to accept insurance, the patient pays.
And according to the law, testing providers can charge any price they want, Pollitz said.
That phenomenon is nothing new in the world of health care. For example, the raw cost to have your appendix removed in Charleston varies between $13,000 and $43,000 depending on what hospital you go to, according to the S.C. Hospital Association. Most patients will never see a bill that high because of their insurance coverage.
Dr. Danielle Scheurer, chief quality officer for MUSC Health, said during a board meeting Oct. 9 the organization makes every effort to make sure there is no cost associated with COVID-19 testing to patients. MUSC has run more than 200,000 tests since the beginning of the pandemic.
"The patient should not have to pay out-of-pocket," Scheurer said.
Patients without insurance might receive a bill, but a spokeswoman said they ultimately won't be responsible for it. At all of MUSC's testing sites, no one is charged at the time of the swab.
DHEC declined to take a stance on the practice of not accepting insurance for COVID-19 tests.
A spokesperson for the agency pointed patients to its website, which keeps a current list of testing providers and indicates where tests are available for free. Each week, DHEC offers its own free testing. The times and locations vary.
The cost of running those tests varies depending on type and the volume of people tested, but it runs the state government, on average, $125 apiece.
The test's price also depends on its type. Generally, there are two kinds of diagnostic tests. MUSC, DHEC and many others largely use the molecular option, also known as PCR tests. Wait-times for the PCR tests have caused frustration at intervals during the pandemic as the demand for needed supplies outpaced availability. Turnaround times have been known to extend to two weeks.
Antigen, or rapid, tests return results on the same day but are known to be less accurate, according to DHEC. The rapid tests have their advantages, however. Fast answers can be of benefit both to the patient and to virus containment efforts. They are also comparatively cheap.
Holy City Med, a hybrid urgent and primary care clinic on Savannah Highway in West Ashley, is charging $80 for one of those rapid tests, and $100 for a PCR test. The clinic's policy is to not accept insurance. Advocates for the model say patients benefit from lower prices overall by brokering directly with the provider, rather than with an insurance company.
Frank Wells, owner of the clinic, said he founded Holy City Med to save patients money on health care. People appreciate the convenience and safety of a drive-thru testing site with a fast answer and a guarantee of no hidden bills, Wells said.
"We run a free market, efficient system," Wells said.
He also said the tests Holy City Med has chosen to use are highly accurate.
At Rapid Results COVID Testing, a test costs $199, the highest price The Post and Courier identified in the Charleston area.
Curtis Bostic, a former Charleston County councilman, business owner and attorney, began the Rapid Results COVID Testing operation because of long turnaround times. Waiting a week or more for employees of the businesses Bostic said he has a stake in to hear news of their test was "economically devastating," he said.
Bostic said the business is mostly relying upon the molecular PCR tests.
The sticker price Rapid Results is charging is higher mainly because of a special agreement between the company and a local lab. Bostic said they have a courier run samples to the lab to be processed right away, rather than mailing the swabs to a large diagnostics company.
"We're not for everyone," he said. "We're for the people who want to get a test result immediately."
For similar reasons, uMedMarket, a company in the Upstate, is charging as much as $300 for an expedited PCR test. Tests are for sale on the website, and once purchased, patients go to a collection site.
Though it charges $300 for a guaranteed 24-hour turnaround time, the company charges only $30 for the standard tests.
Even so, free options are abundant, regardless of insurance coverage.
Joshua Baker, director of the South Carolina Medicaid agency, said in a statement the department has been enrolling adults without insurance in a temporary benefit that will pay for COVID-19 tests since July. The testing provider has to be enrolled in the state Medicaid program.
Roughly 150,000 South Carolinians are covered by that limited benefit.