January 14, 2022
ACHP spoke with The New York Times’ Sarah Kliff about the rushed testing implementation timeline following new federal rules requiring private insurers to cover at-home COVID tests.
Starting Saturday, new federal rules will require private insurers to cover the at-home coronavirus tests that Americans buy in pharmacies and other stores. The new system could, in theory, allow millions of consumers to pick up tests at thousands of locations without spending any money. The reality, at least in the short term, is likely to be messier: Some insurers say it will probably take weeks to fully set up the system the White House envisions.
The new process will be hard, the insurers say, because over-the-counter coronavirus tests are different from the doctor’s visits and hospital stays they typically cover. The tests do not currently have the type of billing codes that insurers use to process claims. Health plans rarely process retail receipts; instead they’ve built systems for digital claims with preset formats and long-established billing codes.
Because of this, some insurers plan to manage the rapid test claims manually at the start.
“This is taking things back to the olden days, where you’ll have a person throwing all these paper slips in a shoe box, and eventually stuffing it into an envelope and sending it off to a health insurer to decipher,” said Ceci Connolly, president and C.E.O. of the Alliance of Community Health Plans, which represents smaller, nonprofit insurers.
Ms. Connolly also criticized the implementation timeline as too rushed, with the government issuing rules on a Monday that are to take effect on a Saturday.
“It is going to be exceedingly difficult for most health plans to implement this in four days,” said Ceci Connolly.
The challenges of insurers may soon trickle down to consumers, who will be responsible at first for navigating their health plans’ reimbursement rules to get their tests covered.