Insurers Balk at Idea of Covering Unlimited At-Home COVID Tests

by Leslie Small

Recently, the Biden administration unveiled a plan to curb COVID-19 infections that promises forthcoming guidance “to clarify that individuals who purchase OTC [over the counter] COVID-19 diagnostic tests will be able to seek reimbursement from their group health plan or health insurance issuer and have insurance cover the cost during the public health emergency.”

Health insurers and health care policy researchers have a bevy of questions and concerns about this plan — and at least one public health expert has floated a different approach.

Unanswered Questions Abound

• “This is new policy for us; insurers are not covering at-home tests unless they were ordered by a provider, and those are very, very limited circumstances,” Michael Bagel, the Alliance of Community Health Plans’ (ACHP) director of public policy, tells AIS Health.
• “Will health plans cover at-home COVID-19 tests directly at the counter? When does the requirement start? Can consumers buy at-home tests now for reimbursement in future?” Krutika Amin, Ph.D., associate director of the Kaiser Family Foundation’s program on the Affordable Care Act, mused in a recent Twitter thread.
• One major question Bagel has is how many tests consumers should be able to receive reimbursement for in any given time period. Health care providers, he points out, would likely not authorize polymerase chain reaction tests on back-to-back days for most patients, so reasonable limits also should be placed on rapid at-home tests.
• But the biggest unknown, Bagel says, is “the fraud, waste and abuse angle,” which could involve submitting false claims, purchasing tests and then reselling them, someone taking more tests than is clinically required.

Insurers That Fund Tests Now Could Save Later

• Rather than ask Americans to pay out-of-pocket for coronavirus tests and then complete the onerous process of filing for reimbursement, “insurers can negotiate directly with manufacturers to purchase tests at a heavily discounted price,” wrote Leana Wen, M.D., an emergency physician, former Baltimore health commissioner and CNN medical analyst, in a recent opinion piece for The Washington Post.
• The Biden administration could then guarantee that everyone who has private or government-sponsored insurance receives a monthly packet of at-home antigen tests, she suggested. For his part, Bagel seemed to endorse Wen’s suggestion sharing her op-ed via Twitter with the commentary: “Great op-ed @DrLeanaWen. @CMSGov must work with @_ACHP on a testing strategy that works.”

From Health Plan Weekly