COVID-19 testing is critically important as it helps reduce the spread of the virus as well as diagnostic so that the virus can be easily treated. Therefore, the American government found ways by which it could expand access to free testing.
The Biden Administration required group health plans and insurance companies to cover for at-home COVID-19 tests cost. Therefore, Americans can go online and order free test kits or purchase them at preferred stores and get reimbursement.
Covid Test Reimbursements in Pennsylvania
Beginning January 15, 2022, private insurance companies will be required to reimburse members for over-the-counter (OTC) tests purchased out of pocket by members (HHS, 2022). Reimbursement, testing, and coding protocols are established based on guidance from federal, state, the Center for Disease Control and Prevention (CDC), and other health agencies (UHC, 2022). However, this report will focus on at-home COVID-19 tests reimbursement in the state of Pennsylvania.
Millions of Pennsylvania citizens will be able to access free at-home rapid tests under the new Biden administration rule. The rule required insurance companies to cover the cost of the at-home tests. Beginning January 15, 2022Citizens covered by private insurers have access to over-the-counter at-home rapid tests.
The over-the-counter COVID-19 tests can be purchased online or at a store or pharmacy, and the cost will be covered upfront by the health plan or through reimbursement. Under the Biden rule, health plans and insurance companies must cover eight at-home tests per covered individual per month. However, the test must be cleared or approved by the U.S Food and Drug Administration.
The Biden administration also incentivized group health plans and insurers to set up a program allowing individuals in Pennsylvania to get at-home COVID-19 tests directly through preferred retailers, pharmacies, or other institutions with no out-of-pocket cost. Individuals with no coverage by a group plan or private insurance can still access free tests in many places in the state, including Simpson Recreation Center and Widener Library (Heinze, 2022).
How to get reimbursed by insurance providers in Pennsylvania
Highmark
The Highmark insurer will begin to reimburse its customers for over-the-counter COVID-19 tests purchased on or after January 15, 2022. The insurer is also working on eliminating the need for members to pay out of pocket first.
Under the Biden Administration rule, Highmark, just like other private insurers, must cover up to eight at-home test kits per member per month. However, the insurer will reimburse for the test purchased on or after January 15, 2022. In contrast, purchases made before the said date will not be covered under the plan.
Members seeking to be reimbursed should submit reimbursement claims online. A receipt will also be required (Rittmeyer, 2022).
UPMC Health Plan
The UPMC health plan announced procedures for individuals and employers covered under the plan to get reimbursed for eligible at-home COVID-19 test kits. The health plan in association with UPMC’s hospital network will only provide coverage for eight tests per individual each month. UPMC Health plan said that individuals insured will not be reimbursed for tests bought before January 15, 2022.
In addition, tests administered or ordered by a health care physician following an individualized medical assessment will continue to be available for its members. The health insurer also said that it would take requests for reimbursement via mail, and the company is working on creating an online system. However, the Biden rule does not extend to Medicare members; UPMC For Life Medicare Advantage customers already have full COVID-19 testing coverage if a health care physician orders testing.
There are two different commercial reimbursement forms for over-the-counter testing under the UPMC Health plan (Napsha, 2022). One is used for retail OTC tests purchased by an individual on their own, and it should not be used for COVID-19 tests administered or ordered by a healthcare provider. The other form is of the same tests purchased on their own; however, it cannot be used for tests your provider or an individual has sent to a lab.
The reimbursement form requires one to provide member information: member ID, city, address, etc., COVID-19 purchased information, including date of purchase, store, the National Drug Code, and Universal Product Code. Other information includes the reason for the test and members’ signatures. The form is then mailed with a copy of a receipt as evidence (UPMC, 2022).
The at-home tests covered include MaximBio ClearDetect COVID-19 Antigen Home Test, BinaxNOW COVID-19 Ag Card, iHealth COVID-19 Antigen Rapid Test, BinaxNOW COVID-19 Ag Card Home Test, among others. The test purchase must be FDA-approved for one to get reimbursed. Since most insurers follow the Biden Administration rule, the maximum amount an individual can be reimbursed is $12 per test kit (UPMC, 2022).
Summary
The Biden administration required private insurance companies and group health plans to cover the cost of OTC COVID-19 test kits and reimburse those that purchased the test kits on or after January 15, 2022. The directive aimed at expanding access to free testing. Pennsylvania, just like most states, adopted the emergency rule; hence millions of its citizens will be able to access free OTC COVID-19, at-home tests online, or from pharmacies. The health plans and insurance companies will cover the cost upfront, or members can get reimbursement for test kits purchased on or after January 15.
The maximum number of tests covered is eight per member per month and the maximum amount to be reimbursed is $12 per test kit. The at-home test kits covered by different insurers include MaximBio ClearDetect COVID-19 Antigen Home Test, BinaxNOW COVID-19 Ag Card, iHealth COVID-19 Antigen Rapid Test, BinaxNOW COVID-19 Ag Card Home, etc. Highmark, UPMC Health Plan, Aetna are some of the private insurers that cover reimbursement for at-home tests. Customers under the Highmark plan can therefore seek reimbursement by submitting their claim form online and should attach their receipt. UPMC Health Plan members can also seek reimbursement by submitting a commercial reimbursement form.
References
Heinze, J. (2022). Insurance To Cover At-Home COVID Tests: How To Get Them In PA. News.yahoo.com. Retrieved January 28, 2022, from https://news.yahoo.com/insurance-cover-home-COVID-tests-182808909.html.
HHS. (2022). Biden-Harris Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests. HHS.gov. Retrieved January 28, 2022, from https://www.hhs.gov/about/news/2022/01/10/biden-harris-administration-requires-insurance-companies-group-health-plans-to-cover-cost-at-home-COVID-19-tests-increasing-access-free-tests.html.
Napsha, J. (2022). UPMC insurance sets COVID test reimbursement guidelines. TribLIVE.com. Retrieved January 28, 2022, from https://triblive.com/local/regional/upmc-insurance-sets-COVID-test-reimbursement-guidelines/.
Rittmeyer, B. (2022). How Highmark and other insurers will cover at-home COVID tests. TribLIVE.com. Retrieved January 28, 2022, from https://triblive.com/local/regional/how-highmark-and-other-insurers-will-cover-at-home-COVID-tests/.
UHC. (2022). Testing, Treatment, Coding & Reimbursement | UHCprovider.com. Uhcprovider.com. Retrieved 28 January 2022, from https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/COVID19-testing.html.
UPMC. (2022). COVID-Testing-Reimbursement_WEB.doc. Upmc.widen.net. Retrieved January 28, 2022, from https://upmc.widen.net/view/pdf/vzcemxfdsh/COVID-Testing-Reimbursement_WEB.doc?t.download=true&u=oid6pr.
