This week, nearly two full years into the on-going pandemic, the Biden Administration told Americans that they would, at long last, be given access to free, rapid COVID-19 tests — a key tool In containing spread of the virus.
The government’s plan was two-fold. On Jan. 15, the federal government implemented rules that require private insurers to pay for home tests. Second, the federal government adopted new regulations on Jan. 15 that require private insurance companies to provide coverage for at-home testing. launched a new website to deliver free rapid antigen tests directly to Americans’ homes.
Public health professionals say that the effort was an important step in the right direction. But it has also been kludgy, overly-complicated—and it doesn’t go nearly far enough, they say.
“It’s a well intentioned effort to try to give people some financial relief,” says Sabrina Corlette, a research professor and co-director of Georgetown University’s Center on Health Insurance Reforms. “But I think it is a highly inefficient, cumbersome and confusing way to go about it.”
The new federal rules require private insurers to pay for eight tests per person each month, people have to get them at specific locations to have their costs covered up-front, and those new rules don’t apply to the tens of millions of people who are on Medicare, Medicaid or are uninsured.
The federal website, for its part, won’t ship antigen tests for 7-12 days — too late to address the spike in new cases this week — and the program is limiting orders to four tests per household, which is hardly enough for people, including frontline workers and caretakers, who need to test regularly.
It can be confusing and cumbersome
The White House unveiled its plan in December to compel insurers to cover the tests, but Department of Health and Human Services didn’t release detailed regulations until Jan. 10—just days before they were set to kick in.
Many insurers, which don’t currently have billing codes assigned to at-home Covid-19 tests and aren’t used to either processing retail receipts or sending physical checks for reimbursement, scrambled to formulate new plans this past week. Numerous FAQs were posted and provided links to printable forms.Every insurer will handle the situation differently. This creates a confusion blizzard with new requirements and protocols.
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For their part, customers find the whole process confusing. Social media lit up with people complaining about their insurers’ forms or asking for advice on how they could actually get their “free” COVID-19 tests. Kaiser Family FoundationAnalysing the data from 13 private insurance companies with over 1,000,000 members revealed that the majority of top plans required customers to mail or print physical forms to get reimbursed for the COVID-19 test. One plan offered the possibility to send its form by fax and three provided an online option.
Ceci Connolly, president and CEO of the Alliance of Community Health Plans, which represents small nonprofit insurers, predicts a nationwide “shoe box effect” — people “are going to be collecting and hanging on to all of these paper receipts, and one day, stuffing them in an envelope and putting them in the mail,” she says. “That raises all kinds of questions about the authenticity. This test kit was used by who? It was a covered member. What was the number of members they had in any given time period? Just endless practicality questions.”
That’s not good for insurers. But it’s also not good for public health. Multiple studies have shown that people are more likely to avoid getting the treatment they deserve if there is an increase in costs. Patients may be less inclined to pay for their medication if they are charged $10 more per prescription. Study of last year’s findings. Half of U.S. adults say they skipped or put off health or dental care in the last year due to the cost, according to the Kaiser Family Foundation’s 2021 Survey on Employer Health Benefits.
Jumping through hoops
Under the new federal rules, insurers are encouraged to set up networks of “preferred” pharmacies or retailers where customers can get the costs of their at-home tests covered up front. People who go to another pharmacy to purchase a test must pay out-of-pocket, and then they will need to submit receipts, paperwork, or other documentation for future reimbursement. In that case, insurers must reimburse up to $12 per test, so if people spend more — and the costs range from $17.98 for a pack of two to $50 for a single test at various retailers — they’re likely out of luck. (If an insurer doesn’t designate “preferred” pharmacies, then it’s on the hook for the whole cost of the test.)
Several of the top insurers are also requiring customers to submit the bar code on the rapid test’s box along with their receipt, so Jenny Chumbley Hogue, an insurance broker in north Texas, has recommended all of her clients keep both their receipts and their test boxes. However, she believes these instructions will discourage customers from following the directions.
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“In essence telling somebody to file a paper claim means either A they’re not going to get [the test] or B they’re not going to file it,” Chumbley Hogue says.
Another wrinkle in the new system is that some insurers, including Humana, Blue Cross Blue Shield of Texas and Premera Blue Cross in Washington, are putting other limits on how the rapid tests can be used, requiring customers to attest that they will not use the tests for purposes such as travel, “recreation,” “entertainment” or “school.”
“For a lot of people who might want to buy tests and keep them in their medicine cabinet for a future use, does that process give you a little bit of pause?” says Corlette. “People might think, what if I have to use this for my kid to make sure he can go to school? Am I now at risk of insurance fraud?”
With all of these hurdles, it might seem easier to stick with the “preferred” pharmacy chosen by your insurance company. Many insurers still have not made arrangements with retailers or pharmacies for at least the first week. Some major insurers announced deals. United Health Care, for example, lists Walmart, Sam’s Club, Rite Aid and Bartell Drugs as “preferred retailers.” But other plans have fewer options or say they will update members soon.
Chumbley Hogue suggests that clients drive through testing locations or schedule appointments at pharmacies to have their testing done. This is because insurance covers the testing.
Connolly claims that smaller non-profit plans that she represents have difficulty finding partners with pharmacies. She says that the greatest problem is the lack of test availability in the United States. Even when health plans make a deal to have a pharmacist or direct their members to a store, they are often out of stock.
“We’re very worried that consumers are going to get frustrated,” she says. “And then you might just have more of that boomerang effect where somebody tried to get tests, they couldn’t and so then they stop.”