Biden Covid test mandate catches insurers off guard: ‘Six-month nightmare trying to get reimbursed’

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In yet another example of the Biden Administration’s penchant for putting carts before the horses, health insurers find themselves scrambling to comply with a new federal rule, which went into effect Saturday, requiring them to cover the costs of eight at-home COVID tests per month.

Many private insurers simply are not in the short-term position to meet those requirements, stating it will take weeks to set up the system envisioned by the White House, according to the News York Times.

The newspaper noted that the difficulty lies in the difference between the over-the-counter COVID tests and the doctor’s visits and hospital stays typically covered.

“The tests do not currently have the type of billing codes that insurers use to process claims,” the New York Times reported. “Health plans rarely process retail receipts; instead, they’ve built systems for digital claims with preset formats and long-established billing codes.”

The White House issued the rules on Monday, giving insurers only four days to prepare and leaving consumers wondering how they will be reimbursed for rapid tests that currently run between $14 and $34 for a pack of two. As out-of-network facilities will cap the insurer’s responsibility at $12 per test, this could mean people will be on the hook for any additional costs.

“This is taking things back to the olden days, where you’ll have a person throwing all these paper slips in a shoebox, and eventually stuffing it into an envelope and sending it off to a health insurer to decipher,” Ceci Connolly, president and C.E.O. of the Alliance Community Health Plans, told the New York Times.

Said Jenny Hogue, a Texas-based insurance broker, a plan as to how the guidance will be handled has yet to materialize. “There will be some people who buy [at-home tests], and then have a six-month nightmare trying to get reimbursed.”

“Retailers need to have a process to capture the right codes, and submit it, and we need to be able to accept it on our end,” Bob Wanovich, a Highmark Health vice president who works on provider contracting, told the Times. “These are the pieces that aren’t there yet.”

Until the infrastructure is in place, consumers are being told to save not only receipts, but test boxes, and Wanovich suggests taking a picture of their test kit’s bar codes.

While insurers frantically sort out their systems to process claims, they are also expressing concerns over testing supplies, which is out of their control, and the shortages consumers have reported in recent weeks.

“The bigger frustration our members have is over finding a test, and I don’t have any control over the supply,” Wanovich told the Times. “We’re working with our providers to figure out who has them, but we know it’s in short supply.”

On Thursday, Biden directed health officials to purchase an additional 500 million COVID-19 tests to be distributed in 4-packs for free to Americans anxious over Omicron, but currently, shipping takes 7-12 days after making the request.


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