Congress required health plans to fully cover COVID-19 testing, but insurance companies say they should only have to pay if tests are “medically necessary” or ordered by a doctor.
ARI SHAPIRO, HOST:
Public health officials are encouraging protesters to get tested for the coronavirus, and as it becomes more widely available, precautionary testing is becoming more common. Insurance companies argue they can’t just pay for everyone to get tested whenever they feel like it. Blake Farmer of WPLN in Nashville reports.
BLAKE FARMER, BYLINE: Lynne Cushing of Nashville says she had been pretty strict about social distancing until the recent protests, which she felt compelled to attend.
LYNNE CUSHING: I had hoped to kind of stay on the periphery or least along the edge a little bit. But I didn’t think about the fact that everybody’s going to be chanting, all these – there’s going to be a lot of forced air, you know, coming out at people in the demonstration.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED PERSON: Show me what democracy looks like.
UNIDENTIFIED GROUP: This is what democracy looks like.
FARMER: So the next day, after marching in her mask, she went to a curbside clinic for a COVID-19 test. Cushing knew health plans had to cover the test and can’t even charge a copay.
CUSHING: Because I have health insurance, I’m lucky in that regard.
FARMER: A law passed by Congress requires health plans to cover medically necessary testing, but as testing capacity grows, a gray area is beginning to appear. Sabrina Corlette at Georgetown University says the law can be interpreted various ways.
SABRINA CORLETTE: That requirement may only apply if you’ve been referred for a test by a health care professional after presenting with symptoms of the disease.
FARMER: Health plans have been erring on the side of patients in paying the full cost. But the nation’s largest insurer, UnitedHealthcare, says in a statement they can only pay for tests deemed medically necessary. Otherwise, they worry about runaway costs. Kristine Grow is the spokesperson for America’s Health Insurance Plans.
KRISTINE GROW: These are some very big numbers that we are looking at.
FARMER: The trade group just funded a study that estimates the cost of all the precautionary testing needed over the next year. More than protesters, they’re concerned about everyone returning to offices that may institute testing requirements. They project it could cost health plans $25 billion a year if the government doesn’t step in to pay.
GROW: And that’s why we think it’s very important to approach testing with a very strategic approach, one that’s based on science and has very clear direction on who gets tested, how often, what that test result means, how we take action and where the funding comes from.
FARMER: Employment attorneys say most businesses aren’t making workers get tested at this point, settling for temperature checks and questionnaires. But at least one industry is already staring down the dilemma of who pays. Christine Thelen is a lawyer with the firm Lane Powell in Portland who represents nursing home companies. She says one-time testing wouldn’t be that big of a deal.
CHRISTINE THELEN: It also adds up for the number of times because, as you know, you take a COVID-19 test today, but that doesn’t mean that three days from now, I don’t test positive.
FARMER: Many states are mandating coronavirus tests for nursing home staff every week. In New York, it’s twice a week. And already health plans are balking at the cost. But Thelen says no worker should be asked to pay their own way.
THELEN: I think employers need to pay for it.
FARMER: As for protesters, many cities are offering to fund the precautionary tests, including in Nashville. Lynne Cushing was right to be worried. She tested positive after the march, though she says she knew the risk.
CUSHING: Absolutely it still feels that way, but I don’t regret it.
FARMER: As gatherings resume, even with precautions, people will need more tests.
For NPR News, I’m Blake Farmer in Nashville.
SHAPIRO: And this story comes from a partnership between NPR, Kaiser Health News and Nashville Public Radio.
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