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.

Go deeper

Sep 17, 2020 - Health

WHO: Health care workers account for around 14% of coronavirus cases

A health worker collecting coronavirus samples in New Delhi on Sept. 16. Photo: Sanchit Khanna/Hindustan Times via Getty Images

Though health workers represent less than 3% of the population in many countries, they account for around 14% coronavirus cases reported to the World Health Organization, the organization announced Thursday.

Why it matters: The WHO called on governments and health care leaders to address threats facing the health and safety of these workers, adding that the pandemic has highlighted how protecting them is needed to ensure a functioning health care system.

Updated 1 hour ago - Health

World coronavirus updates

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

The weekly number of new global coronavirus cases reported last week reached its highest level yet, the World Health Organization said.

The big picture: From September 14-20, there were nearly 2 million new cases, a 6% increase compared to the previous week, the WHO said.

Pandemic may drive up cancer cases and exacerbate disparities

Illustration: Aïda Amer/Axios

Doctors are concerned the coronavirus pandemic is going to lead to an uptick in cancer incidence and deaths — and exacerbate racial, ethnic and socioeconomic disparities seen with the disease.

Why it matters: The U.S. has made recent advances in lowering cancer deaths — including narrowing the gap between different race and ethnicities in both incidence and death rates. But the pandemic could render some of these advances moot.

Get Axios AM in your inbox

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Please enter a valid email.

Subscription failed
Thank you for subscribing!