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Illustration: Aïda Amer/Axios

Some insurers' limits on coverage for coronavirus testing may push the bounds of federal law.

Why it matters: Testing people who aren't displaying symptoms is an essential part of the public health response to the coronavirus, but some insurers appear to be unwilling to pay the full cost of those tests.

The big picture: Congress passed legislation earlier this year requiring insurers to cover all coronavirus tests — including diagnostic and antibody — without cost sharing, and without "prior authorization or other medical management requirements."

  • Implementing guidance issued by the Departments of Labor, Health and Human Services and the Treasury added more detail, stating that tests "must be covered without cost sharing when medically appropriate for the individual, as determined by the individual’s attending healthcare provider in accordance with accepted standards of current medical practice."

Where it stands: Some insurers' policies specifically say that a patient must be showing symptoms in order to get tested without cost-sharing. That may be too restrictive.

  • "All tests, full stop, must be free without cost-sharing," a Senate aide who helped draft the coverage requirements told me. "Members of Congress would be surprised to learn that insurance companies are not covering 'free tests without cost sharing.' "
  • "I don’t think it's open and shut…but I think the stronger read of the statute and the FAQ is that they don’t have the authority to limit it to tests that are medically necessary," said Christen Linke Young of the USC-Brookings Schaeffer Initiative for Health Policy.

The other side: The federal guidance document implementing Congress' requirements leaves room for insurers to impose some hurdles — such as requiring that tests be ordered by a health care provider.

  • "It is possible to interpret the language in [the legislation] to encompass broad surveillance-type testing, but that’s not the federal government's position today, as I read it," said Sabrina Corlette, co-director of Georgetown's Center on Health Insurance Reforms.
  • But some insurers say that it's unclear whether they're required to cover precautionary tests for asymptomatic patients, and many major plans have coverage policies that require tests to be medically necessary or ordered by a doctor. Some have gone further, explicitly requiring patients to be symptomatic.

Some experts say those limits may be illegal, or at least fall into a gray area.

Between the lines: "Medically necessary" — the language many insurers are using — isn't necessarily the same thing as "medically appropriate," the language used in the agency guidance.

  • "Especially given that most states have a 'standing order' for COVID-19 testing, which authorizes any provider to order the testing, this kind of surveillance testing appears to be both medically appropriate and under the supervision of an 'attending' health care provider," Young said.

What we're watching: “If the feds are going to address this testing issue and say to plans and carriers you’ve got to cover tests for anybody who presents whether they have symptoms or not, then we need to have an honest and fair conversation about what that’s going to mean for premiums," Corlette said.

The bottom line: This is going to become increasingly important in real life, as testing becomes more available and employers — especially those in high-risk categories — want to test their workers as a precaution.

Go deeper

Updated 13 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Health: Coronavirus deaths reach 4,000 per day as hospitals remain in crisis mode — CDC warns highly transmissible coronavirus variant could become dominant in U.S. in March.
  2. Politics: Biden says, "We will manage the hell out of" vaccine distribution — Biden taps ex-FDA chief to lead Operation Warp Speed amid rollout of COVID plan — Widow of GOP congressman-elect who died of COVID-19 will run to fill his seat.
  3. Vaccine: Battling Black mistrust of the vaccines"Pharmacy deserts" could become vaccine deserts — Instacart to give $25 to shoppers who get vaccine.
  4. Economy: Unemployment filings explode againFed chair: No interest rate hike coming any time soon —  Inflation rose more than expected in December.
  5. World: WHO team arrives in China to investigate pandemic origins.
Updated Oct 7, 2020 - Health

World coronavirus updates

Expand chart
Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Axios Visuals

New Zealand now has active no coronavirus cases in the community after the final six people linked to the Auckland cluster recovered, the country's Health Ministry confirmed in an email Wednesday.

The big picture: The country's second outbreak won't officially be declared closed until there have been "no new cases for two incubation periods," the ministry said. Auckland will join the rest of NZ in enjoying no domestic restrictions from late Wednesday, Prime Minister Jacinda Ardern said, declaring that NZ had "beat the virus again."

Sep 26, 2020 - Health

U.S. reports over 55,000 new coronavirus cases

Flags on the Washington National Mall on Sept. 22, each representing 1,000 people killed from the virus. Photo: Chen Mengtong/China News Service via Getty Images

The United States reported 55,054 new coronavirus cases on Friday, according to Johns Hopkins University data.

Why it matters: It was the highest single-day increase since August 14, when the country reported 64,350 new cases over a 24-hour span, and suggests that the U.S. has yet to contain the spread of the virus.