The Biden administration said insurers must cover home COVID tests. It didn’t say how

Before the pandemic, American health care was already fragmented. Two years into a pandemic, the system is also understaffed and exhausted

June 28, 2022 5:55 am

he Biden administration requires health insurers to pay for eight at-home, rapid COVID-19 tests per person (File photo).

I read the announcement in January with mixed emotions: The Biden administration would soon require health insurers to pay for eight at-home, rapid COVID-19 tests per person, per month, it said.

What a helpful move to improve testing access for Americans whose jobs, schooling and daily lives expose them to the virus, I thought. Especially during yet another surge in cases.

But I also thought: Why route it through health insurance? Why couldn’t the administration send out more home testing kits? What about people who didn’t have health insurance? And how would this actually work?

“The new coverage requirement means that most consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan,” the announcement said.

People could get reimbursed by submitting a claim to their plan, you say. Hmm. Hmmmmmm.

Before the pandemic, American health care was already so fragmented that it often took an act of Congress (literally and figuratively) to make small steps toward efficiency.

Now, it’s still that way — but two years into a pandemic, the system is also understaffed and exhausted. People are confused. There are so many flow charts on how to navigate life, and those flow charts keep changing. So do the rules on what’s free, what’s covered by insurance, what’s covered by a pandemic program, and which costs are ours to bear.

I am a health care journalist, but I’m also a person who needs health care sometimes. It took a couple of months before I experienced that latest change firsthand.

My daughter is a preschooler. She’s never not snotty. We were planning to visit one of her grandparents, who is very high risk when it comes to COVID-19. I stopped at Walgreens to pick up a couple of kits. I tucked the receipt safely in my wallet.

A few weeks later, on March 28, I finally got around to filing the claim.

My employer’s health insurance plan is the stuff of dreams and legends. But it fell into the second group listed in the Biden announcement: letting insured members choose where to buy their tests and then submit their own claims for reimbursement. Great on the consumer choice side; not so great on the fill-out-confusing-paperwork side.

The claim form was kind of a Frankenstein of workaround medical codes, since the folks who make up codes for insurance billing hadn’t yet assigned codes specific to over-the-counter COVID-19 test kits. The insurance plan also required a second form — “attestation statements” that the purchase was prompted by symptoms or exposure. Finally, it required a copy of the receipt and the UPC bar codes on each test kit.

Two weeks later, my claim was denied. I didn’t do all the paperwork, it said.

But I had! I wrote back, asking them to check again and reprocess the claim. I attached screenshots. I made a plea to their financial wizards: If I can’t rely on you guys to cover a kit, next time I need a test, I’ll have to get one from a doctor, which is a way more expensive claim.

I got an email a couple of weeks later: They sent the claim for reconsideration.

And on June 14, a thick envelope arrived. Inside was a $51.35 check. The claim was actually $50.86 — the other $0.49 was interest.

The insurance company paid me interest — because they couldn’t process my claim right away. They couldn’t process it right away because of a policy that saw fit to entrust a medical claim to some tired lady in Idaho. And that lady’s claim, it turns out, had indeed been filed wrong.

This commentary was originally published by the Idaho Capital Sun, a States Newsroom affiliate. 

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Audrey Dutton
Audrey Dutton

Audrey Dutton is a senior investigative reporter for the Idaho Capital Sun after 10 years at the Idaho Statesman. Her favorite topics to cover include health care, business, consumer protection issues and white collar crime. Dutton hails from Twin Falls. She attended college at Hamline University in St. Paul, Minnesota, and received a master's degree in journalism from Columbia University in New York City. Before coming home to Idaho, Dutton worked as a journalist in Minnesota, New York, Maryland and Washington, D.C. Dutton's work has earned dozens of state, regional and national awards for investigative reporting, health care and business reporting, data visualization and more.