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New Mandate Raises Question: Who’ll Pay for All the Covid Tests?

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Spurred by persistently high Covid case numbers and only modest vaccination rates, the Biden administration announced Thursday a new effort to combat the pandemic. It intends to mandate that workers at large companies get vaccinated, or submit to regular testing.

The rule applies to tens of millions of Americans, about two-thirds of the country’s work force. And it raises a thorny question: Who pays for those coronavirus tests?

Doctors typically charge about $50 to $100 for the tests, so the costs of weekly testing could add up quickly. Federal law requires insurers to fully cover the tests when ordered by a health care provider, but routine workplace tests are exempt from that provision.

“It’s really up to the employer,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. “They can require employees to pick up the tab.”

Employers have so far considered a range of approaches, from fully covering the costs to having unvaccinated workers pay full freight.

When the U.S. government proposed regular testing for unvaccinated workers in August, it also announced that federal agencies would cover the costs of those screenings.

That plan will most likely be scrapped, however, as the Biden administration announced Thursday it would no longer allow the country’s millions of federal workers to test out of the vaccination requirement. Instead, unvaccinated workers now have 75 days to get vaccinated before a disciplinary process could begin.

Among the employers taking a different approach is Rhodes College in Tennessee: It will require unvaccinated students without a medical or religious exemption to pay a $1,500 fee per semester to cover the costs associated with a weekly coronavirus testing program.

Rhodes, a small liberal arts college, estimates that three-quarters of its employees are vaccinated. It is still collecting information about the vaccination rate among its 2,000 students, and it strongly encourages vaccination. But it is waiting until full Food and Drug Administration approval of the vaccines before mandating them.

“This is not a punishment,” said Meghan Harte Weyant, the college’s vice president for student life. “Students who choose to return to campus unvaccinated” without an exemption will have to cover the testing costs, she said. “This is intended to ensure that students who are vaccinated do not have to bear that cost.”

Other employers are having workers chip in for the costs of coronavirus testing. MGM Resorts, which owns many hotels and casinos in Las Vegas, will charge a $15 co-pay for the testing at an on-site clinic for unvaccinated workers, multiple news outlets reported last week. Workers will also have the option to be tested at an outside provider.

MGM Resorts did not respond to a New York Times request for comment on the new policy.

New York and California started testing requirements for unvaccinated state workers this week, but neither has specified who will pay for the service.

Many states and cities still have free coronavirus testing sites that they started earlier in the pandemic. Long Beach, Calif., announced this week that it would require testing for unvaccinated city workers. In a statement to The Times on the new rule, the city said that workers “will have the option to do their mandated testing for free at the Long Beach Health Department” when the requirement takes effect in mid-August.

But many Americans also get tests at doctor’s offices and pharmacies, which will typically bill patients and their insurance for the service.

These disparate approaches could provide a menu of options for many workplaces that fall under the new federal rule, which applies to companies with more than 100 employees. The Biden administration has directed the Department of Labor to draft a rule detailing the new mandate.

Federal law requires insurers to fully cover coronavirus tests ordered by health care providers, meaning the doctor cannot apply a deductible or co-payment to the service. Rules written by the Trump administration, and continued into the Biden administration, excluded routine workplace testing from that requirement.

In practice, insurers do often end up covering employer-mandated tests — it’s hard to tell from a doctor’s bill whether a workplace ordered the care — but they could start reviewing cases of patients who suddenly have claims every week for the same service.

“If they are starting to see a significant number of people who have these tests submitted every week, or twice a week, under federal law they would be within their authority to say this looks like routine workplace testing and not cover it,” said Professor Corlette of Georgetown.

This means unvaccinated workers who have to obtain their own coronavirus testing could have to pay their own fees. Some patients have faced surprise medical bills for coronavirus tests, which can range from a few dollars to over $1,000.

Some of those bills were the result of an employer-mandated test. In the last year, The Times has asked readers to send in their medical bills for coronavirus testing and treatment, and reviewed multiple cases of surprise charges for a workplace-required test.

That includes Marta Bartan, who needed a coronavirus test to return to a job last summer working as a hair colorist in Brooklyn. As The Times reported, she received a $1,394 bill from a hospital running a drive-through site.

“I was so confused,” she said at the time. “You go in to get a Covid test expecting it to be free. What could they have possibly charged me $1,400 for?”

Unvaccinated workers who fall under the new federal rule may benefit from another Biden initiative announced Thursday: a plan to make rapid virus tests more widely available.

That includes making at-home tests available at cost (meaning no profit) from major retailers including Amazon and Walmart, as well as providing free rapid tests at community centers. The White House has announced that these cheaper tests will be available at online retailers “for up to 35 percent less starting by the end of this week.”

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