It seems that the world has gone mad with Covid confusion! We can now add Covid-19 testing to the general conversation of whether we go up or down, or down then up.
Last week, a young adult relative returned to the office. On day one, he returned with handfuls of rapid Covid-19 test kits. Always curious, I asked about that process. He knew no more than to repeat the directions received at work: If you at any point are at home and not feeling well, or feel that you have been exposed to someone with a positive result, just complete the rapid test before leaving home for work, and if a positive result for Covid infection is indicated – time to stay home. And stay there for the next ten days.
Always curious, I had a slew of questions:
How much did you have to pay for the tests?
Do you have to call your physician and let him/her know you are taking a test? Do you have to keep him/her apprised of the results?
How does the expensive and fabulous medical plan you have factor into the cost of the test? Are they charged for the cost of the test?
Did they show you how to administer and read the test?
The sum of the answers:
Nothing, no/no, not at all/not that I know of, and nope.
This I found to be amazing!
The week before learning of all this, I had had a fabulous weekend – two weddings, a celebration breakfast, and very few masks in sight. As this was one of the first times I had ventured out into social situations with other than relatives in my “pod”, I decided it would be prudent to take a “rapid-test” before exposing the adorable but unvaccinated in my family to any danger – a kindergartner, a toddler and a one week old.
I knew that I had a few options;
1. I could make an appointment with my physician and ask for a test
2. I could make an appointment for a test to be administered at my local drug store
3. I could buy a test on Amazon, or any local pharmacy and go rogue
Options one and two required me to “specify” my medical need for a test before being given an appointment and option three required no more than shelling out $23.95 (the common cost everywhere) for a Rapid at-home Abbott Laboratories BinaxNow test. Going rogue would always be my first choice, but it was not to be as the Rapid At-Home antigen test is NOWHERE TO BE FOUND! There is a variety of these self-administered over-the-counter tests, but neither Amazon nor any of my local pharmacies had them in stock.
Shocker – the pharmacies did not have any stock for sale but were more than willing to make an appointment for me to administer the test – while they watched me swab and they read the results. Of course, I asked lots of questions – only to find out that the test the pharmacy was watching me administer was the same test I would have administered myself at home!
Now, this leads to lots of questions. Most of them are financial. The cost to me for the pharmacy to "watch" me take the test? ZERO! I was on a mission! How can it be zero? The pharmacy receipt from the drug store notes: Retail Price: $129.99 Your Insurance Saved You: $129.99
Where is the form for my insurance company? How much are you charging them? Is there special coding so the insurance company will understand the costs? What are all of the costs? If it costs $23.95 over the counter, why is it “free” if I let you watch me take it? Why does the receipt note “Retail Price: $129.99”? It just did not make sense. The burden of being a Medical Insurance Advocate can be overwhelming at times!
I soon got to work. I called the insurance company myself. They told me to wait as the pharmacy had not electronically submitted the bill. I waited one week – still no invoice to the insurance company. I then called the pharmacy – they directed me to their headquarters, as they had no idea who was paying for all of this.
The BIG QUESTIONS:
Why does a test that costs $23.99 over the counter cost $129.99 when an employee of a pharmacy is unnecessarily watching you swab?
Why isn’t my insurance company being billed (after all – I have insurance)?
How is it that there are tests available to be “administered” by a pharmacy, but that same pharmacy has none for sale to the general public?
I would like to say that I have answers for you – but alas, there are none! The insurance company NEVER received a bill. The pharmacy stated that “the Government” pays for it. I reached out to a Primary Care Provider, who told me that had a test been administered through their office, the costs would be $80.00 – billed to the insurance company. Why are medical facilities charging less than a pharmacy? Why does a physician bill through insurance but a pharmacy does not?
As an advocate, it is always a goal at HealthLink to have a clear path to answers when client patients call to ask about help with insurance billing. I still did not have clear answers. Curious, I then decided to call a host of insurance companies, and see how they would handle this. My primary question:
If I were to buy an At-Home Rapid Covid Test at a pharmacy for $23.95, take it home and administer it myself, would the insurance company reimburse me for the $23.95. My goal with this question – is it better to just have a few tests on hand for convenience? What if one has a large family – this could prove to be expensive. After all, one could make an appointment at a pharmacy where they would "watch" an entire family swab, and charge $129.95 per test to the” Government” (none of the pharmacies I spoke with could tell me which agency in the “Government” was covering my test) or I could just buy them and administer from the privacy and safety of home.
Here is a sampling of results:
Medicare
Medicare will pay the entire bill if administered by a lab, pharmacy, physician, or hospital. If you should buy a test and administer it yourself there would be no reimbursement. Of course, as is the case with the test I took, the "Government" would be charged $129.95. Over the counter, the test would be $23.99. Why is the "Government" making it easier to spend over $100.00 more?
Oscar – United Health Care
Oscar will not cover a test that you can purchase in a store yourself – even if it IS the same test the store will watch you take. They do however provide a home testing kit themselves at no charge via the mail, but patients need to schedule an electronic communication through their in-house Urgent Care. A physician will then send a link to a website where the test can be ordered and sent. Sounds complicated!
Anthem Blue Cross
Good for them! Anthem will reimburse you for an "at-home" test. They ask insured clients to "take a photo" of the shelf display price of a test. Attach the photo, as well as a receipt to a claim form, and send it in. The cost of the test will be reimbursed.
A few thoughts here. Time is money – if this test is for one sole person, maybe one could make sense of spending $23.99 to avoid all of the testing drama. However, with a large family, this is a decision that one must weigh carefully.
As far as “Government” agencies are concerned, in my view here the IRS is clearly on the ball. On September 10 of this year, the IRS announced that the “cost of home testing for COVID-19 is an eligible medical expense that can be paid via a Health Savings Account or Flexible Spending Account”. That clear direction from the IRS will be appreciated by the many who manage their medical expenses with pretax dollars – a considerable way to cut medical costs!
Insurance companies and medical facilities all operate on numbers. In this case, the numbers are not dollars – but CPT Codes. A CPT code is an acronym for “Current Procedural Terminology”. CPT codes are medical codes that are used to report medical services between insurance companies and medical facilities, for purposes such as claims processing and guidelines for medical care. This is a big part of the dilemma….purchases made over the counter in a pharmacy (or on AMAZON) are not assigned a "CPT Code". Therefore, there is no way for a pharmacy to indicate to the insurance companies what medical costs are involved in the purchase. That is the big deal here – a pharmacy, physician, or hospital administration of a Covid test does have a CPT Code, which starts the process for which they are reimbursed for not only the test but the cost of administering/monitoring the test.
Earlier in September, Hannah Norman of Kaiser Health News published an in-depth article about the availability and costs of these tests (Why At-Home Rapid Covid Tests Cost So Much, Even After Biden’s Push for Lower Prices | Kaiser Health News (khn.org). We were beyond frustrated at HealthLink Advocates, to read that patients in other countries have so many more options than we here in the states have, with the cost of tests in some countries coming in at under $1.00 per test. It just does not make sense for anyone to pay more than $100.00 to go and have someone watch them swab for the test when it is perfectly acceptable to do this for much less in the comfort and privacy of one's own home.
At HealthLink, we often remind people to be proactive and know what their benefits are. This is an example of a benefit we should all understand. Covid-19 is not going away any time soon. Reach out to your insurance company – you will find the number right on your insurance card. See if they will cover an over-the-counter test. Why wait until you are sick to make an appointment or search for a test available over the counter? For me, I would much rather be proactive and have a test on hand – that is….. if I can find one!