We’ve recently shared a string of examples, from insurers dodging reimbursement for kids’ COVID-19 tests to insurance giant Cigna being sued into covering tests. Now the issue has reached the point where the Centers for Medicare & Medicaid Services (CMS), along with the departments of Labor and Treasury, are stepping in.
CMS has declared that group health plans need to cover the cost of COVID-19 tests, whether or not patients are symptomatic. Why? Perhaps the CMS is as baffled as we are as insurers enjoy financial windfalls from the pandemic while the rest of the country suffers—and still refuse to pony up for virus tests.
The article lays out specifics around the CMS’ mandates for reimbursement, which include deductibles, copayments, and coinsurance, as well as coverage without cost-sharing, prior authorization, or other medical management requirements. Insurers must also cover point-of-care COVID-19 tests and tests done at state or local testing sites—even if a person doesn’t have symptoms or suspected exposure.
A year into the pandemic, we think that it’s about time that health insurers are held accountable for actually covering the care that their members pay for.
