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Federal lawmakers react to loophole that lets private insurers push back on paying for COVID-19 tests

Posted at 6:58 PM, Jun 30, 2020
and last updated 2020-06-30 21:26:10-04

Federal lawmakers on both sides of the aisle are pushing back on a loophole that could give America’s private insurance companies a way out of paying for COVID-19 tests.

In an interview on Tuesday, U.S. Congresswoman Lois Frankel (D- Fla.) said, “when we passed this bipartisan legislation the first thing we thought about was testing, testing, testing. Our federal legislation requires insurance companies pay for the test, that’s the law,” she told Investigative Reporter Katie LaGrone.

U.S. Senator Rick Scott (R- Fla.) agreed adding, “We are facing a public health crisis, and nothing should get in the way of Americans’ ability to protect themselves and get tested for the coronavirus – especially cost,” he said in a statement.

Earlier this week, we revealed a loophole in the Families First Coronavirus Response Act that lets insurance companies break away from paying for COVID-19 screenings if the test isn’t deemed medically necessary.

“Whoever is interpreting it is not medically necessary to get a COVID test now is not living in reality,” Rep. Frankel said.

At Doctor’s Urgent Care Center on Florida’s West Coast, COVID-19 testing has become Dr. David Dean’s number one request.

“The number of COVID tests have just skyrocketed and so has demand,” he told us from his clinic recently.

PREVIOUS COVERAGE: Private insurers scaling back on paying for COVID-19 tests?

Dr. Dean hasn’t confronted any issues so far with private insurance companies footing the bill for the $100 to $150 screening exam. But he fears the loophole could leave him eating the costs of tests.

“I was pretty surprised that there could be denials of payments. It would be outrageous if private companies deny it,” he said.

Sabrina Corlette is a public health policy professor at Georgetown University and explained how insurers could use the gap to their advantage.

“What has happened over time is I think they’ve realized that this can get very expensive very quickly. They’re paying for testing for everybody and in some cases weekly or monthly,” Corlette said. “So what they’ve said is, if you’re sick and you go to a doctor and the doctor says yes let’s get you tested then we’ll cover that. But if it’s for you to go back to the workplace or if it’s for a broad public surveillance exercise then the insurers have been saying we shouldn’t have to cover that, that’s not our job,” Corlette explained.

Recently, the Centers for Medicare and Medicaid issued further guidance regarding when insurers must pay for testing by stating coverage is required when testing is deemed “medically appropriate.”

David Allen, a spokesman for America’s Health Insurance Plans, which is the industry’s top trade association, said in a statement:

“Ensuring that everyone can get the testing they need is a critical tool in the fight against COVID-19. America’s health insurance providers appreciate the additional clarity for commercial coverage from the Centers for Medicare & Medicaid Services (CMS) along with the Departments of Labor, Health and Human Services, and the Treasury, which makes clear the requirement for insurance providers to cover COVID-19 testing when medically appropriate for individuals receiving care from a health care provider.

Defeating COVID-19 will require robust public-private partnerships, as well as coordinated and that is comprehensive public and occupational health strategies to meet our nation’s health goals. As the country reopens and returns to work, these strategies must include more federal guidance as well as funding for testing.

Our commitment is to the health of the patients and communities our members serve. Health insurance providers stand ready to work with public health officials, employers, health care providers, policymakers, and others to develop and execute robust strategies to protect Americans, to identify cases, and reduce the spread of the virus.”

Rep. Frankel advises patients whose insurance denies testing to contact their insurance provider immediately and appeal any denial.

“What medically appropriate means to me and should mean to every person in this country and this world is we have a virus that is spreading very, very rapidly. There’s no cure, there’s no vaccine, people have to get tested,” Rep. Frankel said.