Health Law Daily Wrap Up, HEALTH CARE REFORM NEWS: Kaiser Family Foundation report reveals concern regarding private insurer’s handling of home rapid COVID tests, (Jan 24, 2022)

By Joe Cox, J.D.

The Foundation noted that given an already present challenge in finding rapid tests, many insurers’ reimbursement or direct coverage mechanisms will not do much to improve patient access.

A report from Kaiser Family Foundation considered the policies in effect from private insurers to provide coverage for rapid at-home COVID-19 tests. The Biden Administration recently announced that beginning on January 15, 2022, private insurers would be required to begin covering the cost of such tests when purchased over the counter by insureds. Of course, this requirement supplements existing coverage requirements for tests ordered by providers and conducted on site. The new coverage requirement operates on up to 8 rapid tests per member per month, and private insurers may choose from many processes to provide coverage.

KFF reviewed the policies of 13 private insurers and noted varied approaches to handling the coverage requirement. Six of the 13 insurers analyzed have a direct coverage option under which plan enrollees can purchase rapid tests at an in-network or preferred pharmacy and will not have to pay anything up front. Five of those six insurers also provided a mechanism for enrollees to obtain reimbursement for costs fronted with out-of-network retailers. Also, a seventh insurer is in the process of adding direct coverage but has not yet completed that process.

Meanwhile, seven of the 13 insurers are relying on reimbursement practices and have differing policies. Four of the insurers require receipts and a form to be mailed in, with one offering a fax option, and none offering email or online submissions. Two providers already offer an online option for submitting reimbursement forms.

Ultimately, KFF was concerned that with the already documented shortages of available rapid tests, the differing policies for reimbursement or direct coverage will do little if anything to improve patient access to rapid tests. Of course, the differences in implementation from insurers that are providing direct coverage to those requiring documentation for subsequent reimbursement of fees will likely confuse consumers and could present financial barriers for enrollees whose insurers are still requiring upfront payment. Ultimately, though, KFF termed the new policy as “a step towards improving COVID-19 test accessibility and affordability,” albeit a step that is still fairly confusing for most insurance consumers.

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