The latest in the saga of United’s ascent to the peak of Mt. Miserly is the case being brought against them by the California Medical Association (CMA). As reported by Healthcare Dive, the charge is “failing to adequately reimburse physicians for COVID-19 rapid antigen testing.”
Wait, what? This is July 2021, not 2020, right? Wasn’t this issue put to rest after multiple rounds of legislation spelled out that health insurers are legally required to cover coronavirus diagnostic tests? All the way back in March, we covered a story about the Centers for Medicare & Medicaid Services declaring that group health plans needed to cover the cost of COVID-19 tests and stop shirking testing costs.
And now here we are, well over a year into the pandemic, and we’re still seeing insurers not covering tests. This time, United (along with fellow insurer Anthem) have been reimbursing doctors at less than half of the rapid antigen tests, which cost $35 to $40 each, Healthcare Dive reports.
The CMA published a statement calling on state regulators “to formally investigate and take appropriate action to ensure payors are not impeding patients’ access to appropriate and necessary COVID-19 testing and profiting at the expense of treating physicians.” In the statement, the association asks regulators to investigate reports that some insurers are shifting financial risk to healthcare providers by reimbursing them “at rates far below the cost of the test.”
The Dive story notes that the CMA learned that their statement may have had an impact. United sent notifications to “some pediatric and family medicine practices” to the effect that the insurer would “increase reimbursement” for the COVID-19 tests, supposedly to 100% of the CMS rates.
To us, that sounds less like, “We apologize, and we’ll make it right,” and more like, “Okay, we got called out again, so we’ll make a promise for the moment and then… well, you just check back with us later.” We’re hoping that the CA state regulators will keep on the insurers and ensure they follow through.
