Payers: At-home COVID-19 test coverage will drag reimbursement into 'the olden days' upon rollout

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Under a time crunch, payers are bracing for a messy rollout of a new federal rule requiring insurers to cover at-home COVID-19 tests, The New York Times reported Jan. 14. 

The rule was introduced Jan. 10 with an implementation date of Jan. 15. But Bob Wanovich, Highmark's vice president of ancillary provider strategy and management, told the Times his company would need weeks to set up the framework to reimburse members.

"The guidance came out Monday, and we started working on it immediately, but I don’t have a mechanism ready to go, Day 1, where you don’t have to pay up front," Mr. Wanovich said.

The dissonance stems from the fact that at-home tests lack the billing codes payers rely on for reimbursement. Until a system is established, Ceci Connolly, president and CEO of the Alliance of Community Health Plans, said a physical reimbursement process by which customers submit receipts may be required. 

"This is taking things back to the olden days, where you’ll have a person throwing all these paper slips in a shoebox and eventually stuffing it into an envelope and sending it off to a health insurer to decipher," Ms. Connolly told the Times

Jenny Chumbley Hogue, a Texas-based insurance broker, told the Times that implementation delays may throw members into a "six-month nightmare trying to get reimbursed." She has been encouraging members to save test receipts and boxes. 

However, Mr. Wanovich told the Times that although insurers still face the challenge of creating preferred pharmacy networks for at-home COVID-19 tests and navigating reimbursement challenges, consumers face a larger challenge: finding accessible, reliable tests. 

 

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