I received a statement for my COVID test, what should I do?

Start by calling the membership number on the back of your card or checking their website (most now have information on their website for who to contact specifically for COVID test reimbursement). Insurance companies typically respond quicker to patient-initiated calls.  

What is an Explanation of Benefits (EOB)?

An EOB is a statement from your health insurance plan describing what costs it will cover for your medical care.  An Explanation of Benefits is NOT a bill!  The EOB is generated when your provider submits a claim for the services you received. It will show:
  • The cost of the care you received
  • Any out-of-pocket medical expenses you’ll be responsible for. This should be none for COVID tests.

Why does it say my deductible wasn’t met?

The Coronavirus Aid, Relief and Economic Security (CARES) Act requires group health plans to provide COST FREE coverage of COVID-19 testing during the national public health emergency period. This includes co pays, deductibles and coinsurance and applies to ALL commercial plans (including self-funded and employee sponsored plans), Medicare and Medicaid plans.  Your insurance company is responsible for ensuring there is no out of pocket cost to you.

My explanation of benefits (EOB) says my test wasn’t covered because it was not done by an in-network provider, what does this mean?

Your health plan’s typical rules for out-of-network care do not apply to the coronavirus test, and your insurance carrier is responsible for payment.

My insurance company said the claim wasn’t submitted properly…is this true?

Our COVID visits are ordered by a licensed health care provider and inclusive of screening, specimen collection and send out to a laboratory for processing with results provided to each individual, adhering to the requirements for coverage. The specimens obtained are sent to a third party laboratory facility for processing who abide by the same standards.

I’m still not sure what to do….

If you are unable to reach your insurance carrier or you still have more questions, please contact our billing department at 619.258.6200 or send an email to billing@coastalfamilyuc.com.
More detailed information may also be found on the Department of Managed Health Care website at: https://www.dmhc.ca.gov/.