Who pays for COVID testing that’s vital to the fight but not to a patient?
Good intentions may have informed the Trump administration’s recent guidance instructing insurers to cover the full cost of medically appropriate tests for COVID-19.
Either way, where the policy could be helping real people as well as broad subpopulations, the move is snagging on that two-word phrase modifying tests.
Kaiser Health News drills down into the problem and offers some illustrative anecdotes in an article posted July 20.
As the pandemic has fanned out and shifted shape, the definition of medically appropriate “has both broadened and become fuzzier,” KHN reporter Julie Appleby writes.
Public health and workplace safety are important indications, she notes, but they’re generally not medically necessary.
Not surprisingly, the uncertainty is fueling another Washington-based fight over money allocated to the pandemic response.
“What is clear: Insurers have argued against requirements that they waive all cost sharing for workplace COVID testing, noting they don’t do that for other screening efforts, such as drug-testing programs,” reports Appleby, who also mentions parents concerned about sending untested kids off to camp or daycare.
Congressional Democrats have accused the Trump administration of “giving insurance companies loopholes instead of getting people the free testing they need,” KHN points out.
And as the article asks, who should be expected to pay:
- When all employees are required to have a negative COVID test in order to return to work?
- If a factory tests workers every two weeks?
- When someone wants to know for their own peace of mind?
The answers will matter to many.
For patients caught in the middle, out-of-pocket costs can range anywhere from $20 to $850, KHN reports.
And the aforementioned industry group has said it would cost between $6 billion and $25 billion a year for COVID screening at the population level.
Meanwhile the potential for patients to overdo the testing if payers were mandated to cover it, no questions asked, will surely complicate discussions going forward.
“In the end, consumers may … feel a resulting pinch in the form of higher premiums,” Appleby writes.
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Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.