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Yesterday a famous Italian singer, Vasco Rossi, posted on Instagram saying that confirmed COVID-19 cases in USA are low because very few people are checked due to the test costing $3,200. (In Italy, the National Healthcare network is testing every person which may have been in contact with an infected and has compatible symptoms.)

It roughly translates as:

Coronavirus ..which..has arrived in California.. there are few confirmed cases !?๐Ÿคฃ ..because tests cost 3,200 dollars (yes you got it right) and of course very few can or will afford to do so. This explains why magically here the emergency is not as serious as ours in Italy ๐Ÿ‡ฎ๐Ÿ‡น๐Ÿ’™๐Ÿ’ฅ Who knows how many people are already ill or will be ill and CNN and STRUMP won't have to worry about it ๐Ÿ˜œ Think about it people... think!

Is it true that in the USA the COVID-19 test costs $3,200?

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    Related: politics.stackexchange.com/questions/50624/… (tl;dr: CDC covers testing but those may not be the only medical bills incurred...after that, it gets complicated, because institutions have some discretion on whether they bother to bill uninsured folks, for reasons of both collection efforts and PR). – Bryan Krause Mar 6 at 17:37
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    It appears that it was bureaucratic problems (also here) rather than cost that led to inadequate testing. – Harry Johnston Mar 6 at 21:48
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    The Economist is reporting "Test kits made available by the Center for Disease Control (CDC) were faulty; restrictions were limiting tests in other settings. By March 1st, when South Korea had run 100,000 tests for the virus, America - which saw its first case on January 23rd - had run fewer than 500." – Henry Mar 7 at 2:36
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    I don't know ๐Ÿคช about you, but I tend to ๐Ÿคฃ take the words of people ๐Ÿ‘ช who ๐Ÿ˜œ overuse emoji with a grain of ๐Ÿง‚. – AleksandrH Mar 8 at 17:27
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    Came back from China to California with flu-like symptoms (early February), went to hospital, told them, was put in isolation room, got a bunch of tests done, none of them COVID-19, when they were satisfied it was the flu was kicked out unceremoniously, the whole experience cost upwards of 3,000 and did not include a test. So quote is about right. – PatrickT Mar 9 at 1:50
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That would appear to be a total misrepresentation of what happened.

USA Today reported on the incident.

The person was charged something over $3000 for an emergency room visit, but:

  1. That was the total for examination and treatment in the emergency room at a hospital in Florida.
  2. It includes tests for 22 other "upper respiratory pathogens."
  3. It does not include a test for COVID-19 - the person involved was not tested for the Corona virus. The hospital checked with the Florida Department of Health, and was told it was not necessary to do a COVID-19 test on this particular person.
  4. The person involved was diagnosed with the flu.

The article does mention that a COVID-19 test in the emergency room could cost some patients up to $1000 - but that is more due to the cost of the emergency room visit than the test itself.


The article also quotes a speaker for the New York State Department of Health saying that the state health department pays for COVID-19 tests.


I've checked the FactCheck.org article on the incident:

  1. All COVID-19 tests in the US are conducted by two agencies: The New York State Department of Public Health, and the Center for Disease Control and Prevention.
  2. Neither organization charges for the test.

You (and/or your insurance) will have to pay for emergency room services if you go to the ER, but you (or your insurance) won't be billed for the COVID-19 test itself.


The proper action if you suspect you have COVID-19 is not to run to the emergency room. According to USAToday, you should call your doctor. The doctor will then contact the public health office in your area for instructions on how to get you tested.

If you show up unexpectedly in the ER, then you are just another patient and will be handled (and billed) the same as any other ER patient. COVID-19 testing can (probably) be handled through the ER, but that is not what you should do.

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    "All COVID-19 tests in the US are conducted by two agencies: The New York State Department of Public Health, and the Center for Disease Control and Prevention." โ€” This is no longer the case. A number of state health department labs perform tests now (see, for instance Nebraska, which reports the number of tests they have performed) and commercial labs Quest and LabCorp are beginning testing as well. – Zach Lipton Mar 9 at 0:18
  • Comments are not for extended discussion; this conversation has been moved to chat. Please don't post your opinions of the US Health Care system here. – Oddthinking Mar 10 at 14:27
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I am writing this aswer because many have a misunderstanding of how the US healthcare system works.

The test is free, as discussed by JRE's top answer. Access to the test is in the $100 range.

Rossi did not understand how the US medical system works

Which is to say, the person used the US medical system very inefficiently.

The US does not have single-payer state-provided healthcare. Americans either fall under a government insurance program like VA or Medicare, or private insurance like Blue Cross, or go uninsured.

For insurance programs, only certain doctors and hospitals are "in-network" meaning they have agreed on payment rates. Someone on a private or government plan chooses an in-network doctor to be their primary care physician, if they refuse to choose, one is assigned, but this can be overridden.

There are also urgent care centers everywhere, about half as common as McDonald's restaurants. They provide similar services to PCPs but with longer hours. They serve both insured patients after-hours, and act as PCPs for the uninsured. Their visit fees are $75-150 depending on market. Not great, not bad though.

So for insured people, there is a triage: the PCP for things which can wait until a possible appointment, then in-network urgent care, then an in-network ER, then an out-of-network ER. Plans will cover out-of-network care in some cases including ER services. Plans have a 24x7 advice-nurse line to help you triage.

Uninsured people who are able to pay their bill, can use a similar priority: first to any PCP they have a relationship with on a cash basis, then to an urgent care, then to an ER. That is most cost-efficient.

Uninsured people who cannot pay have the simplest triage (the ER), but it is a sad story (for accountants); we'll get to that.

So the person should have gone to PCP or an Urgent Care center and gotten evaluated by a doctor. The doctor would examine (through interview) travel history, past contacts, and other risk factors, reported and apparent symptoms, and then determine which tests are medically indicated. since the doctor's goal is not to screen for Coronavirus, but to heal the patient. That is exactly what was done at the ER; they screened for several things and found a simpler disease (flu) that explained the symptoms; as a result did not do a Coronavirus test. The doctor is thus a gatekeeper to the testing system. The test may be free, but the doctor must be paid.

Gatekeeping is even more important given the shortage of test kits.

ER prices really are that crazy

There is a special rule for ERs: they cannot turn away a patient in urgent need. That means they are a magnet for the uninsured. PCPs or Urgent Care will stop them at the receptionist. So the uninsured just go straight to the ER for everything, even though it is an inefficient (high real cost) way to provide most types of care.

This is a fiscal problem for the hospital. For the insured, insurance only pays very low, negotiated and competitive rates for ER services (say: $300 for the actual ER visit), which approximate the real cost of providing the service in an ER setting. There's no margin there. The best place to recover losses to the uninsured is from the minority of cash patients who do pay.

On the other hand, in many foreign countries, the belief among their wealthy is that the US has the best care in the world. So the system, particularly hospitals, gets a lot of cash business from foreigners.

This has created a perfect storm for obscene retail prices for ER services, that do not reflect the genuine cost for providing the services. Since the indigent won't pay, retail prices are tuned to get the most from the wealthy who will pay. Although it is true that getting non-emergent care in an ER is much more expensive than at a PCP or Urgent Care, it is nowhere near the $3000 reflected in that retail hospital bill. This indeed is an artifact of how America does business in the medical business.

When insurance is billed, they are billed at the obscene retail rate, as claimed. Not mentioned is that the insurer goes "sh'yeah right, see our contract", or if out-of-network, the insurer haggles it down to something vaguely resembling contract rates (mind you, this happens every day; they all know each other, and it's old-hat for everyone).

That US ER's charge $3000 for a walk-up that involves a blood test: True.

By the way, someone confronted with such a bill should haggle ruthlessly and unrepentantly to cut that bill to a fraction.

The person chose the least efficient method for care

Perhaps not knowing the system (never having dealt with health issues before), the person went to a hospital. 90% of hospital business is complex specialist care which flows from a referral from a PCP, e.g. For an MRI scan or to see a podiatrist. But all that business walks in the side door during business hours, not in the ER (the ER has instant access to it, that being an advantage). Perhaps the person expected that the hospital would have a walk-up clinic service comparable to a PCP or Urgent Care that would efficiently triage: determine the most effective/efficient path to care. Nope: the only option they have for walk-up triage is the ER, which is equipped for anything (and you pay for that).

The person could have had the test done for no more than the cost of a doctor's visit and blood draw at a normal PCP or Urgent Care.

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