Starting Saturday, new federal regulations will require private insurance companies to cover home coronavirus tests that Americans buy at pharmacies and other stores. The new system could, in theory, allow millions of consumers to take tests in thousands of places without spending money.
Reality can be more annoying, at least in the short term. Some insurers say it will probably take weeks to fully set up the system that the White House envisions.
According to insurance companies, over-the-counter coronavirus testing is different from regular doctor visits and hospitalizations, making the new process difficult.
Currently, the test does not have the type of billing code that the insurance company will use to process the claim. Health insurance rarely processes retail receipts. Instead, they built a system for digital claims with preset formats and well-established billing codes.
For this reason, some insurers are initially planning to manually manage their diagnostic claims.
“This goes back in time and people throw all these paper slips into shoeboxes, eventually pack them in envelopes and send them to health insurance companies for decryption,” said Ceci Connolly. , President and CEO of the Alliance of Community Health Plans, which represents a small non-profit insurance company.
Connolly also criticized the implementation schedule for being too urgent, and the government will issue a rule on Monday and take effect on Saturday.
“Most health insurance will find it very difficult to do this in four days,” she said.
Insurer challenges may soon reach consumers. The consumer is initially responsible for navigating the health insurance reimbursement rules to cover the inspection.
“Some people will get a refund in a six-month nightmare after buying them,” said Texas-based insurance broker Jenny Chumby Hogue. She hasn’t seen the plans she’s working on, sending member guidance on how coverage is handled.
Not knowing what the rules will be, Hogue advises the client to save not only the receipt, but also the box that contains the test. This is because some plans may require a box as proof of purchase.
The White House issued a statement to the New York Times on Friday urging patients to keep receipts for the tests they purchased. Most importantly, these tests will be covered for free from Saturday. “
Some public health experts criticized the plan as unnecessarily complicated and said the Biden administration wanted to provide patients with free kits directly.
“Providing cheap tests directly to Americans is the easiest from the consumer’s point of view,” Lindsey Dawson, associate director of the Kaiser Family Foundation, told the Times earlier. “Someone will need to know that it is redeemable, navigate the redemption process, and prepaid the cost first.”
Other countries are spending more on quick testing. In the UK, citizens can use the government website to order free quick inspections for home use. Germany has invested hundreds of millions of dollars to create a network of 15,000 rapid test sites. Instead, the United States has focused on efforts to promote public purchases of vaccines and their intake.
Some local governments in the United States have invested heavily in rapid testing to counter the latest wave of incidents. In Washington, where cases of the virus have increased significantly, residents are now able to receive four free quick tests daily at the city’s library.
The Biden administration has relied heavily on tests performed in the clinic instead. Federal law has required insurance companies to cover them free of charge since the early months of the pandemic.
Under the new rules, private insurance companies will be required to cover eight home coronavirus tests for each person each month. This rule does not retroactively apply to home exams that Americans have already purchased, and does not apply to patients with public insurance such as Medicare or Medicaid.
Under the new rules, consumers who are tested in the “favorable” place of health insurance will have to pay in advance. In other words, the patient does not pay anything at his own expense. The locations that count as “priority” locations vary from plan to plan, but in many cases you expect these facilities to be already networked with a particular insurance company.
Consumers going to stores outside the network will have to submit a receipt for a refund and the plan will only pay $ 12 per test (or $ 24 for a kit that includes two tests). .. If the sticker is expensive, the patient will pay an additional fee.
Health insurance that does not specify a set of “priority” locations must cover the entire cost of the test receipt submitted by the member.
Test prices currently range from $ 17.98 for two packs to $ 49.99 for individual tests, according to a study conducted by Dawson last week.
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Highmark Health, a non-profit plan with approximately 6 million members in Pennsylvania, plans to build a network of “priority” locations, but will not be ready by this Saturday.
“The guidance was announced on Monday and we started working right away, but on the first day without the need for prepayment, there is no ready mechanism,” said Bobwanovich, vice president of Himark. I am working on a provider contract.
One challenge that Wanovich and others explained was that insurers usually do not cover over-the-counter pharmacies such as pregnancy tests and non-prescription drugs.
“Retailers need to have the process of getting and submitting the right code and we need to be able to accept it,” he said. “These are the parts that aren’t there yet.”
Until they set up the infrastructure (a process that can take weeks), Highmark Health advises patients to submit a receipt with a photo of the test kit barcode for a refund. ..
The Capital District Physicians’ Health Plan, a small insurance company in upstate New York, will instruct members to hold inspection receipts as they organize their systems for processing inspection receipts.
Ali Skinner, Vice President of Communications for the Plan, said:
Skinner said the insurer is still working to secure a designated “priority” location by Saturday, so patients can be tested without a refund process. She wasn’t sure if it would meet the deadline.
“We are now against time,” she said. “It’s a big lift for us. We discovered it at the same time consumers went on Monday.”
Even when insurers are organizing systems for processing claims, they remain out of control with one major factor: supply testing and the shortages consumers have faced in recent weeks. I noticed that.
“The big complaint our members have is about finding a test and I have no control over the supply,” said Wanovich of Highmark Health. “We work with providers to figure out who has them, but we know they are in short supply.”
