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

Federal act calls for payment only if test is medically necessary
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Posted at 6:44 PM, Jun 29, 2020
and last updated 2020-06-30 11:56:38-04

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.

Dr. Dean hasn’t confronted any issues so far with private insurance companies footing the bill for the $100-$150 screening exam. But we’ve learned that could soon change.

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

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A loophole in the Families First Coronavirus Response Act, which was passed by Congress in March, requires insurance plans pay for testing but only when testing is determined to be medically necessary. The caveat doesn’t apply to patients who utilize county health departments for testing but instead, choose to get tested at their private doctor’s office.

Dr. Dean didn’t know about the loophole until we told him.

“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.

“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, released the following 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 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.”

Corlette believes the problem of sorting out who pays for testing in the future will require Congress to act.

“Congress needs to be thinking about more than just insurance mandates, but how we get everybody covered regardless of your insurance status,” Corlette said.

Back at Dr. Dean’s urgent care clinic, he and his staff are just trying to keep up with all the demand knowing he’s doing his part during the pandemic and he hopes insurance companies do their part.

“This is not just about testing people at highest risk, let’s be fair to everyone and pay for it,” he said.

Experts advise consumers to contact your insurance provider and ask them about their coverage plans directly. If necessary, also make sure your doctor documents that your COVID-19 testing is medically appropriate.