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”

Washington, DC – Today, Patients Over Pharma called on Secretary Azar to issue clear guidance to stop private insurance companies from skirting the Families First Act and CARES Act by charging patients for COVID-19 tests.

“Secretary Azar needs to step up and issue clear guidance to make sure private insurance companies comply with the letter and spirit of the law and not force patients to foot the bill for COVID-19 tests,” said Eli Zupnick, spokesman for Patients Over Pharma. “While public health officials are encouraging people to get tested and Congress has clearly weighed in saying that patients should be protected from testing costs, it’s absolutely wrong and dangerous for private insurance companies to use this as an opportunity to pad their already bloated profits.”

On April 27th, Accountable.US’s Kyle Herrig wrote an op-ed calling on Congress to protect patients from drug and insurance company price gouging, saying: “Insurance companies must cover all coronavirus testing, treatments, and vaccines without copays or deductibles for the duration of this crisis. Trump has taken some steps to ensure that Medicare and Medicaid cover testing, but they don’t go nearly far enough and don’t include the millions of Americans covered through private insurance companies.”

Additional background 

Families First Act & CARES Act Required Private Insurers To Cover Coronavirus Testing Without Copays

Families First Act Required Private Insurers To Cover Coronavirus Testing Without Cost Sharing, Prior Authorization Or Other Requirements“The CARES Act would build on the new coverage provisions in the Families First bill (outlined in more detail here). Under Families First, all comprehensive private health insurance plans must cover FDA-approved testing needed to detect or diagnose coronavirus and the administration of that testing without cost-sharing or barriers (such as prior authorization or other medical management requirements). Coverage extends to any services or items provided during a medical visit—including an in-person or telehealth visit to a doctor’s office, an urgent care center, or an emergency room—that results in coronavirus testing or screening. This coverage requirement began on March 18 (when Families First was enacted) and remains in effect while there is a declared public health emergency (as defined under federal law).” [Health Affairs, 3/26/20]

CARES Act Expanded On Families First By Not Limiting Tests To Those Approved By FDA. “The CARES Act builds on this requirement, at least for private plans. The bill would broaden the testing that would be covered without cost-sharing beyond FDA-approved testing to include 1) tests provided by labs on an emergency basis; 2) state-developed tests; and 3) any other tests determined appropriate by the Department of Health and Human Services (HHS). This amendment recognizes that access to coronavirus testing, while improved, remains spotty with tests available only through certain labs. By explicitly extending the Families First provisions to these testing services, the CARES Act would help ensure that consumers will not face cost-sharing based on the entity or lab that developed their test.” [Health Affairs, 3/26/20]

Provisions Regarding Testing Access Without Cost Sharing Were To Be Enforced By HHS, Labor And Treasury Departments. “These provisions of the bill would be enforced by the Departments of Health and Human Services (HHS), Labor and Treasury. The agencies could implement this requirement through sub-regulatory guidance or program instruction, meaning the changes could be adopted quickly (rather than waiting on a more formal regulatory process).” [Health Affairs, 3/16/20]

In Spite Of Federal Requirements, Patients With Private Insurance Coverage Are Being Charged For Coronavirus Testing

Majority Of Americans With Employer Coverage Are On “Self-Funded” Plans Offered Through Larger Employers – Many Self-Insured Plans Are Operating As Though They Are Exempt From Requirement To Cover Testing. “The issue comes down to an interpretation of whether the new federal legislation applies to health plans offered by larger employers. Those companies, which usually have at least a few hundred employees, often use their own money to pay claims as a way to drive down costs. A survey by the Kaiser Family Foundation finds a majority of Americans with health coverage are in this type of plan. So BlueCross BlueShield of Tennessee may be on an employee’s insurance card, but the insurer is just managing the payments. The employer’s money pays the claims; these plans are often called self-funded or self-insured, and it may not be clear to employees that they are in such a plan. According to multiple sources, many of the companies with those plans are operating as if they’re exempt from the new federal rules. “In this case, it appears that the law may have left self-insured employers out of certain elements,” said Mike Thompson, CEO of the National Alliance of Healthcare Purchaser Coalitions.” [Kaiser Health News, 5/22/20]

Axios: Insurers Including UnitedHealthcare And BlueCross BlueShield, Are Charging Coronavirus Test Copays For Patients Even When Their Doctors Have Ordered The Testing. “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.” [Axios, 6/10/20]

Public Health Experts Confirm Widespread Testing Is Essential To Contain Spread Of Coronavirus. “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.” [Axios, 6/10/20]

Headline: Axios: “Insurers limit which coronavirus tests they’ll pay for.” [Axios, 6/10/20]

Insurance Companies Continue To Profit Tremendously Through Pandemic

Headline: Kaiser Health News: “Health insurers prosper as COVID-19 deflates demand for elective treatments.” [Kaiser Health News, 4/28/20]

Headline: Reuters: “U.S. health insurers benefit as elective care cuts offset coronavirus costs.” [Reuters, 4/27/20]

UnitedHealth Spent $1.7 Billion On Stock Buybacks In First Quarter Of 2020. “Former Cigna executive turned industry critic Wendell Potter disagreed. He tweeted earlier this month that UnitedHealth spent $1.7 billion during the first quarter to buy back its own stock—a move that helps the company. “In other words, they’re thriving during a pandemic,” Potter tweeted. Instead, he said, the insurer should plow that money into premium reductions or other help for policyholders.” [Kaiser Health News, 4/28/20]

Moody’s Predicted Insurance Companies Would Remain Profitable Throughout Pandemic“Backing that assessment was a report out last week by credit rating agency Moody’s, which looked at a range of pandemic scenarios—from mild to severe—and concluded that “U.S. health insurers will nonetheless remain profitable under the most likely scenarios.” [Kaiser Health News, 4/28/20]

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