Jun 10, 2020 - Health

Insurers limit which coronavirus tests they'll pay for

Data: The COVID Tracking Project; Chart: Andrew Witherspoon/Axios

Some large health insurers are only willing to cover coronavirus testing under certain circumstances — potentially undermining a key part of the U.S.' coronavirus response.

Why it matters: Widespread, easily accessible testing is an essential part of containing the virus, and the U.S.' testing capacity has gotten much better. But insurance restrictions that deter people from getting tested could undermine that progress and put people in danger.

The big picture: Public health experts say testing needs to keep increasing, especially in high-risk places like nursing homes, and for people with a high likelihood of exposure — for example, from a public-facing job or participating in protests.

  • Many employers are interested in using widespread diagnostic testing as a workplace safety tool.

In most circumstances, a coronavirus test costs an insurance plan roughly $50.

Yes, but: Some insurers aren't willing to cover purely precautionary tests, or at least won't do so without cost-sharing.

  • They're only extending that benefit to tests that are deemed "medically necessary" and which have been ordered by a doctor, and in some cases they explicitly exclude the types of regular surveillance testing that experts say is so important.

Details: UnitedHealthcare, for example, says that “we will cover medically necessary COVID-19 testing at no cost-share...when ordered by a physician or health care professional.”

  • BlueCross BlueShield of South Carolina will cover diagnostic tests “when ordered by an attending health care provider and provided at the point-of-care for individuals who are symptomatic and are concerned about infection,” per its website.
  • Blue Cross and Blue Shield of Kansas City will cover both diagnostic and antibody tests “with no cost share if you have symptoms consistent with COVID-19 and your physician orders the test,” according to its website.
  • BlueCross BlueShield of Mississippi says it won't cover tests that are “not medically necessary," which includes tests for asymptomatic people as part of public health monitoring efforts or screenings for returning to work.

The other side: Not every insurer has added coverage limitations. Aetna, which is owned by CVS, has waived cost-sharing for all diagnostic tests, which “can be done by any approved testing facility.”

What they're saying: Insurers have never typically covered medical services that aren't ordered by a health care professional, or that aren't considered medically necessary, and they say it's unclear whether they should be on the hook for such services now.

  • They generally understand "medical necessity" to refer to situations in which a patient is exhibiting symptoms or has been directly exposed to someone with the virus.
  • “It is essential that strategies that addresses workplace testing be part of an overarching public and occupational health strategy, and that federal guidance clearly articulate the roles of insurance providers, employers and public health officials. It is also critical that these strategies consider related funding in that context,” said Kristine Grow, a spokeswoman for America's Health Insurance Plans.

The bottom line: There are clear health, economic and societal benefits to coronavirus testing, meaning that there’s a plausible argument for insurers, employers and the government all having a role in funding it.

  • But if that role isn’t articulated, it’s nearly inevitable that the bill is going to ultimately land in patients’ lap, just as it has following other payment disputes.
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