A Hospital Forgot to Bill Her Coronavirus Test. It Cost Her $1,980.

The New York Times is investigating the costs associated with testing and treatment for the coronavirus and how the pandemic is changing health care in America. You can read more about the project and submit your medical bills here.

When Debbie Krebs got the bill for a March emergency room visit, she immediately noticed something was missing: her coronavirus test.

Ms. Krebs, a lawyer who focuses on insurance issues, had gone to the Valley Hospital in Ridgewood, N.J., with lung pain and a cough. A doctor ran tests and scans to rule out other diseases before swabbing her nose. A week later, the medical laboratory called, telling her it was negative.

Ms. Krebs had a clear memory of the experience, particularly the doctor saying the coronavirus test would make her feel as if she had to sneeze. She wondered whether the doctor could have lied about performing the test, or if her swab could have gone missing. (But if so, why had the laboratory called her with results?)

The absence of the coronavirus test made a big price difference. Congress, Ms. Krebs had heard, barred insurers from charging patients for visits meant to diagnosis coronavirus. Without the test, Ms. Krebs didn’t qualify for that protection and owed $1,980. She called the hospital to explain the situation but immediately ran into roadblocks.

“When I called the hospital, they said, ‘You did not get a coronavirus test,’” she said. “I told them I absolutely did.”

Across the country, Americans like Ms. Krebs are receiving surprise bills for care connected with coronavirus. Tests can cost between $199 and $6,408 at the same location. A coming wave of treatment bills could be hundreds of multiples higher, especially for those who receive intensive care or have symptoms that linger for months. Services that patients expect to be covered often aren’t.

This patchwork of medical billing is one reason we’re starting something new today: soliciting your medical bills. We’re asking you to send us copies of your bills for coronavirus testing and treatment, so we can understand what costs look like across the country. We want to know how patients are managing their medical bills in the midst of a pandemic. This is part of our larger effort to understand how the pandemic is reshaping American health care.

American medical billing is unlike that of any other developed country. The government does not regulate health care prices, but instead lets insurers and hospitals negotiate fees. Those deliberations happen in secret, and patients often do not learn the cost of their care until a bill shows up in the mail.

Sometimes, insurers give reporters a peek at their data. That’s how I learned that a laboratory in Texas had charged $2,315 for individual coronavirus tests. But more often, they keep that information confidential, which is why we need readers’ bills and explanation-of-benefit documents for any care related to coronavirus.

Readers’ bills have already shown that surprise medical bills for coronavirus have been in the United States nearly as long as the disease itself.

In late February, an American man and his 3-year-old daughter were hit with medical bills totaling thousands of dollars for care received during a government-mandated quarantine. This was only weeks after Washington State announced the country’s first known case.

“I assumed it was all being paid for,” Frank Wucinski, the patient, said at the time. “We didn’t have a choice. When the bills showed up, it was just a pit in my stomach, like, ‘How do I pay for this?’”

The federal government has since resolved to give Americans special protections against outlandish medical bills. Congress enacted new rules to make the tests a rare oasis within the American health care system — the price had to be public; and co-payments, deductibles or other charges weren’t allowed.

Or at least, Congress tried to. The experiences of patients who had or suspected they might have Covid-19 show how hard it is to write different billing rules for a tiny sliver of the country’s $3 trillion in health spending. Numerous doctor’s offices and hospitals do not post the cash prices for their coronavirus tests, despite the federal requirement to do so. Some patients have encountered unwarranted co-payments as doctors and hospitals have stuck to their regular billing habits. Others have failed to qualify for the protections because they did not receive a coronavirus test as part of their care — or, in the case of Ms. Krebs, had it left off the bill.

Aside from mandating that Covid-19 tests cost the patient nothing, there are no new rules to protect insured Americans from coronavirus treatment bills. Health policy experts worry that even those with good insurance could end up facing high costs. One outcome they envision: A patient goes to an in-network hospital for coronavirus treatment, but that hospital is overwhelmed and has no beds left. The patient is transferred to an out-of-network hospital, and gets significant bills as a result.

“Our system is so complicated,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. “If things aren’t exactly right or weren’t coded correctly, you get thrown into the blizzard.”

The protections that do exist are based on the receipt of something that can be in short supply: a coronavirus test. If doctors can’t obtain a test and turn to other diagnostic methods — testing for other diseases, for example — the patient will have to cover the visit’s cost.

The Trump administration has also set aside an undisclosed sum to pay for uninsured Americans’ testing and treatment, a program that has become increasingly important as millions have lost coverage in the economic downturn. So far, that fund has paid out $348 million to providers, but it is unknown how much money remains or what happens when it runs out.

Billing challenges have persisted, despite these new rules and programs. Many stem from the decision by legislators to condition aid on receipt of a test.

Dr. Kao-Ping Chua, a pediatrician in Michigan, started running into problems in March when he had patients with coronavirus-like symptoms seeking tests. His health system, like many others, required patients to undergo testing for other conditions before coronavirus.

“I had to tell my patients that, if the test I run first comes back positive and says you have the common cold, you’ll have to pay for it,” he said. “But if you test negative, that allows you to get the Covid test, and that waives your cost sharing.”

Luciano Aita, 35, sought treatment in early July at St. Mary’s Medical Center in San Francisco after his “chest started closing up” and he felt as if he couldn’t breath.

“I was super scared and worried about Covid, since I never had experienced anything like that before,” he said. A doctor checked his blood pressure, listened to his lungs and took his temperature — but did not administer a coronavirus test. He recalls being told that the emergency room was giving the test only to “critically ill” patients, and he did not qualify.

Mr. Aita, who lost his job at a record store at the start of the pandemic and is uninsured, received a document at the end of his visit estimating he would owe $1,157. If the hospital had tested him for coronavirus, the federal fund could have covered the visit entirely.

Last week, he received a medical bill for the visit that was only $350. He initially thought this was good news — that the hospital had dropped his charge. But when he looked into the issue, he learned this was an additional charge from the doctor who saw him.

“I understood that if it was related to Covid, it would be taken care of,” Mr. Aita said. “It’s a pandemic, I’m unemployed, and now I’m dealing with the stress of this situation.”

A spokesman for Dignity Health, which owns St. Mary’s Medical Center, said the hospital uses C.D.C. protocols to decide who is tested, but he declined to comment on Mr. Aita’s case.

“We have suspended billing patients for their portion of their bill for the testing and treatment of Covid-19 while we work with insurers and the government to exhaust financial assistance options for patients,” Chad Burns, the spokesman, said. Mr. Aita, however, does not appear to qualify for those protections because he did not receive a test.

As coronavirus spreads and hospitalizations mount, so will the ranks of those managing unexpected bills.

The Kaiser Family Foundation estimates that a fifth of all coronavirus hospitalizations could result in a surprise medical bill from an out-of-network doctor who became involved in the patient’s care. The nonpartisan foundation also projects that, on average, an American with employer-sponsored coverage would face $1,300 in costs for a coronavirus hospitalization.

Congressional staffers working on the issue say they’ve come across cases in which health providers are not following the new rules on coronavirus billing. The providers are charging patients for services when they shouldn’t, or not posting their cash prices for testing online as they are legally required to.

“Billing offices may just be doing what they’re used to — looking at your card, seeing that it says $30 co-pay and collecting it,” Ms. Pollitz said. “The person at the front desk may not know you got a test. The protections aren’t airtight.”

Congress is currently split over how far to go in protecting coronavirus patients from surprise medical bills. House Democrats have supported mandating that insurers cover all costs related to treatment as part of the HEROES Act, a larger stimulus package.

Senate Republicans introduced their stimulus proposal, the HEALS Act, last week. It does not include a similar mandate.

In the case of Ms. Krebs, she shared her bill with me after reading another article I wrote about coronavirus test billing. Together, we tracked down a record for her coronavirus test to prove that it did indeed occur.

Two days after I inquired about the case, the Valley Hospital resubmitted her bill with the coronavirus test included. Her insurer, Aetna, reprocessed the bill and confirmed that she would no longer be charged.

“We were trying to come up with extraordinary processes quickly to react to the many changes placed on all of us, including payer requirements of coverage,” Josette Portalatin, an assistant vice president at the hospital, wrote in an email to Ms. Krebs. “We apologize that your lab Covid test was not on your original claim, but happy to report we tracked down the issue.”