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Editor’s note: This is the first in a series of special reports produced through the News + Record’s Facebook Journalism Project COVID-19 grant. The project is funded through the fall. For more, see additional content on “La Voz,” the project’s dedicated Facebook page.
In the pandemic’s early days, Chatham Hospital and Piedmont Health Services shouldered the brunt of COVID-19 testing in Chatham County, but other sites have come along since.
Six medical providers are offering COVID-19 tests in Chatham County, according to a chart released by the Chatham County Public Health Department in early July.
Besides Chatham Hospital and Piedmont Health’s Siler City and Moncure clinics, four other centers are accepting appointments: Avance Care in South Chapel Hill, Central Piedmont Urgent Care in Siler City, Pine Ridge Urgent Care in Pittsboro and the CVS on U.S. Hwy. 15-501.
The Chatham News + Record spoke to representatives from each center about testing procedures, costs and more. Here’s what you need to know:
Chatham Hospital and Piedmont Health Services have been testing Chatham residents for COVID-19 since the earliest days of the pandemic, according to Mike Zelek, interim director of the Chatham County Public Health Department. By comparison, some Chatham private providers have only recently begun offering tests to residents.
Zelek called Chatham Hospital’s Respiratory Diagnostic Center “an ongoing community testing event” since their “testing capacity is pretty large.” Though limited initially, testing at the hospital ramped up once UNC Health brought it in-house.
Right now, Chief Medical Officer Andrew Hannapel said they’re probably testing between 30 and 60 people a day. Likewise, Piedmont Health Services — a Federally Qualified Health Center — is “absolutely busy” testing residents, according to Piedmont Health’s CEO Brian Toomey.
Piedmont Health has four testing centers across North Carolina, and two are clinics based in Siler City and Moncure. After 21 weeks, they’ve completed over 5,000 tests.
“And at each of our sites, we’re probably doing anywhere from — depending on the size and time — 25 to 40 a day,” Toomey said.
They’ve also held mass testing events in Chatham and Lee counties. In April, they worked with the North Carolina National Guard to test Mountaire Farms workers following a COVID-19 outbreak, and they’ve held numerous community testing events in Sanford, including one on July 28. At those events, Toomey said, they test about 300 people each day.
Other Chatham testing centers, mostly private providers, say they aren’t as heavily trafficked. Central Piedmont Urgent Care, a facility in Siler City, has been testing anywhere between five and 25 residents in a 12-hour period, according to tech Erica Galvan.
Pine Ridge Urgent Care in Pittsboro and Avance Care in Chapel Hill report similar numbers. Pine Ridge’s office manager, Gail Collins, said physicians complete 10 to 12 tests a day, though numbers vary. Likewise, Avance Care’s Chief Medical Officer, Joanne Fruth, said the average number of tests they administer a day was close to 10.
“We’re able to see just about anybody the same day for (a COVID-19) test,” said Bill Kilgore, a physician assistant at Avance Care.
To get tested by Chatham Hospital, Hannapel told the News + Record that patients need to schedule an appointment by calling 919-799-4050 and selecting “1” on the keypad.
“It’s a number you call to get into and speak to one of our front desk personnel,” he said, adding, “They will ask for basic information (and) demographic information.”
Likewise, all testing sites save Central Piedmont Urgent Care require patients to make testing appointments by phone or online.
“We’re a walk-in clinic, but we can also do appointments if needed,” said Central Piedmont’s Galvan. “All you would do is you would walk in (and) let us know that you’re here for a COVID test.”
The CVS on Hwy. 15-501 requires patients to schedule appointments online. They are not taking appointment requests by phone, and patients must be North Carolina residents over 18 years old.
“Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing,” CVS Health spokesperson Tara Burke told the News + Record. “Once they have registered, the patient will be provided with an appointment window for that same day or up to two days out.”
Avance Care’s Kilgore said patients can schedule a telemedicine visit to determine whether they should get tested. If care providers determine they should, he said, then patients can schedule a time to do the test.
“A lot of times, we can go the same day or very next day,” he said. “If you’re going online, you can actually see any available openings in the schedule, and you can actually schedule yourself.”
Patients can’t just walk in, Kilgore said, especially not if they’ve been exposed or show symptoms.
“We’re doing all telemedicine visits for (anyone who potentially has COVID-19) so that we can still see our other patients with chronic illnesses in the clinic and keep them healthy,” he added.
People need to call ahead to schedule a COVID-19 test, said Pine Ridge office manager, Gail Collins, and no one can walk in unannounced.
“We ask that you call into our office — 919-542-4450,” she said. “Don’t come to the door. We’ll come out to you. We do everything over the phone. That way there’s not any undue exposure.”
Collins also said patients must complete telemedicine visits, which they can do from their cars in the urgent care’s parking lot. The clinic is still seeing patients on “an urgent-care basis,” so patients may have to wait for testing.
“Say you had an appointment at 2 o’clock,” Collins said. “If I have every room full of Urgent Care patients, we’re going to try to call you and move your appointment back so you’re not having to sit out there and wait. We want everybody to be as safe as possible, and we want to do this as efficiently as possible.”
Chatham Hospital doesn’t actually administer tests in the hospital, said Chief Medical Officer Andrew Hannapel.
“While (the testing is) on hospital grounds, it’s actually behind the hospital in the Medical Office Building parking lot,” he said. “There’s a tent set up.”
Patients will drive up, stay inside their cars and wait to be seen by medical personnel. After asking for the patient’s information, staff will administer the test — pushing a long swab deep into one nostril.
Likewise, Toomey told the News + Record that Piedmont Health clinics all carry out drive-thru testing.
“You should come a little bit early just to make sure you’re there and all set,” he said. “Sometimes people miss their appointments, and so sometimes you get in sooner rather than later.”
Upon arriving, he said patients should see a tent with medical staff wearing masks, gloves, face shields and some kind of body covering. Staff members will ask patients questions about symptoms and make sure they’re wearing masks. Then staff swab patients, which Toomey called “a lot easier” now than in the past.
“You’d have a little Q-tip put up one nostril and a Q-tip put up the other nostril,” he said, adding that staff would “put it in a little plastic bag,” thank the patient and then verify contact information.
“The best way to make sure that people can get in touch with us is if you leave a cell phone number that people can text the results,” he said, “because what takes a lot of time for results sometimes is us trying to track people to be able to talk to them because we’re not sure. We don’t necessarily want to leave a message.”
Most other centers have patients follow similar procedures. CVS notes on its website that patients will follow instructions set up on-site, and others ask that patients call upon arrival.
As a walk-in clinic, Central Piedmont Urgent Care brings patients inside to be tested, Galvan said. After registering them, she said staff would bring patients back, measure their vitals, go through their medical history and then administer the test. The center has two different tests for adults and children. While staff use long, nasal swabs for adults, Galvan said they used “little Q-tips” for babies and children. They do not test babies younger than six months.
The entire appointment, she said, should take between 15 and 20 minutes but no longer than half an hour.
Most insurance companies cover the cost of a COVID-19 test, and those who bring their insurance cards won’t be responsible for any out-of-pocket costs.
“If you are using insurance, you will be asked to provide an image of your insurance card and will need to verify your identity when you arrive for your test,” CVS Health’s Burke told the News + Record.
Likewise, most, if not all, other testing centers will bill patients’ insurance for the test and require them to bring some form of identification.
It’s a bit more complicated for uninsured residents.
Thanks to federal coronavirus aid legislation, most uninsured patients won’t have to pay for a test. Congress allocated billions of dollars to reimburse providers who offered COVID-19 testing or treatment to uninsured residents.
But according to CVS Health and Central Piedmont Urgent Care representatives, COVID-19 tests are only free for uninsured patients who present social security cards, drivers’ licenses or state IDs.
“If you do not have insurance, we will submit the cost of your test to a COVID-19 program funded by the Department of Health and Human Services for the uninsured,” Burke said. “In accordance with the uninsured program rules, you will be asked to provide either a driver’s license, State ID or social security number.”
Central Piedmont’s Galvan said they can’t accept passports or other forms of ID. Without a social security number, driver’s license or state ID, she said patients tested at Central Piedmont Urgent Care have to pay a service fee of $120. On Sept. 1, that fee will go up to $125.
At Pine Ridge Urgent Care, Collins said uninsured patients would have to pay a $100 self-pay rate for the test itself but other charges may be added on as part of the patient’s visit. Likewise, Avance Care charges uninsured patients for the COVID-19 test, but Kilgore said the amount varies.
“It depends on whether you’re coming in or doing telehealth,” he said. “The test itself is around $50, and then an office visit for self-pay is $100 for telemedicine and $150 for an in-office visit.”
Only Piedmont Health clinics and Chatham Hospital offer uninsured residents free COVID-19 testing without requiring identification.
“Whereas you pay a fee to see a doctor, for the testing there’s not a charge” for either insured or uninsured patients, Toomey said, adding that just over half of the clinic’s patients are uninsured.
But if you have an insurance card and picture ID, bring both, Toomey said.
“We will need to see what insurance people have or don’t have,” he said. “Your insurance really should pay before your tax dollars pay because your tax dollars should be the last resort and only resort, but if that is the only resort, then your tax dollars will pay.”
Likewise, Chatham Hospital’s Hannapel said uninsured residents will not receive a bill for a COVID-19 test, but residents may face other charges if they elect to see the drive-thru’s on-site doctors or check into the Emergency Department. The hospital’s drive-thru testing center has doctors on site whom residents can see if “they are sicker than just needing a test,” Hannapel said, and if uninsured residents choose to see these providers, they would be charged as in any other doctor’s appointment. He also said patients will automatically incur a cost of care if they check into the Emergency Department, or ED.
“You don’t need that if you’re just coming for testing,” he said.
But if patients avoid the ED and don’t see on-site doctors, they will not be charged. Hannapel said the hospital does ask patients to bring some form of state or federal ID but will not deny free testing to those without it.
“If you do not have it, we will still see you,” he said. “We will take people on their word. (We would like to) collect their social security number and provide it so that later on we can get reimbursed to HRSA and (the) federal government, but we will not deny people testing if they do not have a social security number.”
All of Piedmont Health’s sites are bilingual, according to Toomey. Chatham Hospital’s Hannapel said they have bilingual front desk personnel.
“Once a person gets on, and it’s noted that they’re Spanish speaking,” Hannapel said, “we hand that over to the person who is bilingual and Spanish speaking on our side.”
Avance Care and both urgent care centers have at least one bilingual staff member that can assist Spanish-speaking community members.
“If somebody comes in (and) if they don’t speak English or Spanish, say they speak French, we have an interpreter line that we are able to call,” Central Piedmont’s Galvan said. “And we’re able to communicate that way with our patients.”
The CVS on U.S. Hwy. 15-501 does not have Spanish-speaking employees, spokesperson Tara Burke said, but there’s one at a CVS in Durham.
Since UNC Health took over testing from LabCorp, Chatham Hospital’s Hannapel said patients should get test results back between 24 and 72 hours.
In North Carolina, three labs — Quest Diagnostics, LabCorp and the state lab — complete the majority of the testing, said Toomey, and when demand ramps up, the time it takes to turn around results increases. A couple of weeks ago, high demand pushed back the turnaround time to up to 10 days. Now, the average turnaround time for tests sent to LabCorp — the lab many Chatham testing centers have partnered with — is about two to three days, according to a company spokesperson.
Misty Drake, Piedmont Health’s chief operating officer, said lately people tested in their clinics have been receiving their results in about three to five business days. Central Piedmont’s Galvan, Pine Ridge’s Collins and Avance Care’s Kilgore said patients should expect to receive their results in three to four days as of right now. People might also receive results the same day if they undergo Avance Care’s rapid antigen test, which Avance rolled out on Aug. 3.
All Chatham testing centers say they follow state and CDC testing criteria, which have since expanded to include a broader swath of people.
Beyond essential workers and those exposed to the virus, people with or without symptoms can get tested if they belong to populations at higher risk of exposure or severe cases, like those from historically marginalized populations, protesters and individuals with underlying health conditions.
“We always find the reason within those parameters to test because people have a right to know and right to be tested with all of the stuff that’s going on,” Chatham Hospital’s Hannapel said, adding, “We’re swabbing everybody because that’s the right thing to do.”
Central Piedmont’s Galvan said they also swab people whose jobs require them to be tested.
“(If) somebody just hasn’t had any symptoms, (was) not around anybody, and they just want to be swabbed because they want to be swabbed, we do that as well,” she said.
Galvan and others also told the News + Record that they don’t share any health information with governmental agencies.
“We don’t check documentation status,” the Health Department’s Zelek said. “That’s something important for our community to know. That’s not part of what we do. Our concern is to look out for the health of individuals, their families and our community, and that’s what public health does.”
Galvan said they only alert the Health Department about new positive cases to allow them to reach out to people diagnosed with the virus.
“Everything here is confidential,” she said. “Once you come in these doors, that’s it. Everything stays in between the four walls of this facility.”
Reporter Victoria Johnson can be reached at email@example.com.