Insurers are mandated to provide, eventually, no cost anti-gen testing kits to commercially insured members.
As noted elsewhere on the blog, the US government portal is EASY.
That is not the universal case for insurers:
Here’s Cigna’s form for covid rapid test reimbursement, which needs to be printed and either mailed or faxed. I wonder what percent of Americans own a printer? https://t.co/qCtLd1LiO3
— Hannah Recht (@hannah_recht) January 18, 2022
Save the receipt *and* the test box (or at least a photo of the barcode). I've had some insurers tell me they are going to require both for reimbursement, since a receipt may not have the information they need to process the claim. https://t.co/uXEXJOEK77 https://t.co/flV4ofxob6
— Sarah Kliff (@sarahkliff) January 14, 2022
This is a great study of WANT TO versus HAVE TO.
Let me divert for a minute to July 1996.
I was a slob (and a bit of an asshole) as a teenager. I usually kept my room just clean enough to avoid getting grounded. And that minimal level of orderliness was usually the result of a lot of sullen eye rolling, muttered comments under my breath and a decent chance of an argument with at least one of my parents. That summer I was working 50-60 hours a week at two jobs. Two of my sisters worked at an overnight summer camp. My parents decided to take a vacation. They asked if I wanted to go with them and my two youngest siblings or I could stay home for the week, not burn the house down and make the money that would pay for part of my semester in Paris four years later. I stayed home and worked my ass off.
I had the house to myself. Most of the week that meant I got up at 5:30, went to my first job, headed to my second job, got home at six, ate, and then went out until a bit too late with friends. It was a good week.
That Friday night, I had half a dozen friends over. My room was spotless. I was excessively motivated. One of the people who came over was a brunette with questionable judgement (she thought I was cute). I was not going to blow my chance with her by having Hanes boxers sitting in the middle of the floor. Keeping my room clean was, at that moment a WANT TO situation. My parents were slightly surprised at how clean the house was on Saturday evening when they came home (especially as I had managed to get rid of the pizza boxes and beer bottles in a community recycling center that morning).
And now back to antigen testing….
Antigen testing is primarily designed to produce public health externalities by reducing chains of transmission as individuals who are not currently symptomatic can identify an infection and change their behaviors to reduce transmission risk. There are some internalizable gains as some treatments are better the earlier they are started but most of the value of antigen testing is through the creation of externalities.
Government is fundamentally a way to solve collective action problems where coordination matters and winners compensate losers. Insurers fundamentally care about internalizable gains and losses. They fundamentally care about the benefits that their premium paying members can collect. Government is in a WANT TO situation. Insurers are in a HAVE TO situation. They are being told to do something that does not immediately align with their business case incentives.
Creating situations where WANT TO and HAVE TO align is a challenge but when a HAVE TO is also a WANT TO things get easier.
Kent
I’m not sure why this is so complicated.
I don’t have to clip off the labels and print a form to get reimbursed for say my statin prescription. I just go to the pharmacy (or order online) , show my insurance card, and it is taken care of.
Why is this any different from any other reimbursement for pharmaceuticals. They should be able to handle it at the point of sale.
Bansihar Kadiya
Great Content. I love this guide. It’s quite useful.
Thanks!
Jerry
I’m pretty sure that the spouse and I now have covid. We’re still awaiting our test results from yesterday morning, but we’re both feeling mighty low right now. The kid is still exhibiting symptoms so she’s doing the school from home again today. Her covid journey started last Thursday.
What symptoms are we exhibiting? Mostly just nasal stuffiness, a sore throat, and a light dry cough. But now my ears are getting all stuffy now as well. The wife and kid are having appetite issues, but I feel like I could eat a whole cow right now. Weird.
Oh yeah, the wife and I are fully vaxxed with a booster. The kid is fully vaxxed (under 12)
Jerry
We get our testing through one of the Wake County sites. Specifically the Mako Medical site that is operating in the Wake Med Soccer Park parking lot. If you live around here and want a test done, go there no later than 8:00 AM. You’ll get your test done pretty much right away. You don’t need to make an appointment, but need to check in beforehand to get some sort of unique ID to show the workers on site.
dc
Luckily, I only have to show my insurance card in the pharmacy.
Lobo
I also think this is an excellent case of administration friction and its impact on the outcome. The USPS has been deluged(very friction free except for apartments right now). The other case.. Just thinking of going out to buy them, save the receipt, print out form and send it in. Maybe later.
JCJ
Yeah, but did you score?
Kent
I just went to order my 4 free tests from the USPS and got back a message saying that someone already put in an order from my address. So I guess my wife is already on it.
Ocotillo
United Healthcare here, they have a list (3 at the moment) of pharmacies where you can show your card Rite-Aide and Walmart are two of them, the third someone I have not heard of. Otherwise, you may purchase and upload receipt via a portal ($12 max).
PJ
This highlights why having insurance to cover health care costs and having insurers act as gatekeepers to health care is such a bad idea. Government and insurance are both cost sharing, but Insurance is also a highly systematized form of gambling – people pay regular premiums to offset the rare likelihood that the thing insured will be damaged or destroyed.
But health care is not a random event – it is something everyone needs on a regular basis, and which, as they grow older, will become more frequent and often more serious. People don’t want to gamble with that – they want access to treatment at an affordable price. Instead, we have a system where the House (the Insurer) has every incentive to make it difficult for insureds to collect on their legitimate claims (since that cuts into profits) and to deny access to health care (which also cuts into profits).
That people have to jump through these hoops to get reimbursed for Covid tests is just one small example of how the incentives in the system are so screwed up.
Roger Moore
@Kent:
This is different from other purchases because it’s assumed to be a one-time, or at least short-term, thing, while many other drugs are long-term. For a one-time thing, you’re more likely to eat the cost and save the insurance company money, while for a regular expense you’ll eventually figure out the rigamarole and get reimbursed. But your response will be different, too. Eating a one-time cost is a lot less likely to make you shop for a different insurance company than having to jump through a bunch of hoops every month for a medicine you have to take for the rest of your life.
Roger Moore
@PJ:
I would say this is an argument against for-profit insurance rather than an argument against insurance more generally. Take away the profit motive, and the worst aspects of insurance also go away. I still agree that something like NHS is probably the best solution- VA for all rather than Medicare for all- but just requiring all insurance companies to be non-profit would be a huge win.
Bill Arnold
That’s tight. Stealing.
Kent
@Roger Moore: I don’t know why one-time vs ongoing makes any difference. A lot of pharmacy drug purchases are one-time like say antibiotics. I’m just saying that insurance companies already have a reimbursement mechanism for pharmacy purchases. Most of them are online with all the big pharmacy chains. This shouldn’t be any different. You should be able to go to Walgreens, show your insurance card, and walk out with your no-cost test kits with the insurance company covering the cost.
I don’t know if the administration mandate specifies this or if insurance companies are deliberately setting up a separate reimbursement method, or if this is just the alternative system for those who buy from a pharmacy that doesn’t do direct billing. I’m with Kaiser and when you go to a Kaiser pharmacy it is all automatic anyway. But I haven’t tried to go get a test kit from a Kaiser pharmacy either.
David Anderson
@JCJ: Nope — but the causal factor of failure was not cleanliness of the room.
HinTN
@JCJ: Exactly! With a bonus for settling the boxers or briefs question.
Bill Arnold
Though many households use a single insurance provider, so helping to reduce in-household transmission (which is a large part of SARS-CoV-2 transmission) could help the provider.
HinTN
@Ocotillo: Those two are ubiquitous so that plan is excellent, IMO.
HinTN
@David Anderson: LOL ?
newtons.third
It has always amazed me that so many people prefer to have their health choices dictated to them by corporate accountants. It is not in the interest of an insurance company to pay out any more than is minimally possible to keep you healthy enough so that you continue to be a source of income. And whatever they can do to keep from paying you is the job of the person who looks at that claim to determine if it meets their requirements.
Phylllis
Our state health plan is requiring a printed form (one for each covered member for whom tests were purchased), mailed, with the purchase receipt and the UPC/bar codes cut from the package*. So, we have to print forms, purchase padded envelopes, and purchase postage to get these reimbursements.
*And provide a reason on the form as to why we purchased the tests.
Phylllis
@Kent: The government is supposedly incentivizing insurance companies to provide them the easiest way possible-at point of sale. Apparently the incentives are not enough to make insurance companies give a damn.
gene108
@Kent:
I think part of the friction is insurers setting up agreements with retailers to reimburse them directly for an OTC product, where retailers agree to receive what the insurer pays, versus being able to sell an OTC product at their usual markup or whatever the market will bear.
Scout211
So far, Tricare and Tricare-for-Life will not reimburse. They may review this, but currently we are not being reimbursed for the retail purchases.
Military.com
Skookum in Oly
I don’t understand why the tests are being sent, for free, to my address, but I have to go out to buy, and hopefully get reimbursed for, my N95 masks? How does that make any sense? Why can’t the Feds just mail N95 masks to me at no cost?
Scout211
@Skookum in Oly:
Here is the text from the White House twitter. They are sending free masks to local pharmacies and health centers in the community. But why not our homes? Good question.
Leto
I see she left her glasses at home… :P
@Scout211: Honestly, ask me how surprised I am at that? You get three, and the first two don’t count.
Kent
They already built the whole mail order site for test kits. One thinks they could just modify it so that you could order test kits, masks, or both.
But what do I know.
David Anderson
@Leto: I had plenty of good beer (we were drinking Sam Addams a lot that year) and yeah, she had thick glasses
ProfDamatu
I suppose I should hold off on praise until it actually goes live, but my insurer is both offering reimbursement (looks like no claim form, just member name, policy number, and receipt, though it does need to be mailed) AND working with a corporate partner to send tests directly to members’ homes. Apparently this partner will have a website at which one can order up to 8 tests per month using one’s insurance policy ID, and tests will be sent “within 48 hours.” That sounds great if it actually happens; my skepticism rests solely on the fact that the projected availability date for the partner website on the insurer’s site has gone from “next week” last Friday, to “this week” yesterday, to “soon” today. Fingers crossed….usually this company is fairly decent in terms of customer service.
Leto
@David Anderson: “If the women don’t find you handsome, they should at least find you handy.” – Red Green
Old School
@Skookum in Oly:
I would suspect it is the size of the packaging. Delivering 50 extra envelopes per route is probably inconvenient for the carrier, but doable. Delivering 50 extra boxes per route may overload the system.
trollhattan
Jeez, I know why college students purchase tests, is this a trick question?
MagdaInBlack
@Leto: I had forgotten all about Red Green. Thank you for rekindling that memory. My husband and I loved him.
Suzanne
FYI, in case you are still having a hard time getting any tests, Gopuff has them. They appear to restock every day, so check in the morning, and they deliver to your house.
Starfish
@newtons.third: Sometimes, the insurance companies are better aligned with your health outcomes than the infinite possible choices. In the infinite possible choices, there are some medical providers who are doing nonsense that costs a lot and does not help a lot.
Ryan
I know for a fact that you and I are of comparable generations, and yet our teenage years look nothing alike. Curious.
David Anderson
@Ryan: what, trying and failing to get laid is not a universal teenage experience?
Ella in New Mexico
Single.
Motherfucking.
Payer.
Sorry, David, but this is going to be my response to a lot of your posts, as insightful as they may be.
The day we stop pretending “insurance” is good healthcare and flip to a single payer system should become an national holiday.
David Anderson
@Ella in New Mexico: 218-51-1-5
Will be my counter to your counter.