Philly-area insurers pledge coronavirus test coverage

As the number of coronavirus cases in the United States grows and testing becomes more available, insurers and lawmakers are preparing for how to pay for testing without leaving patients with unexpected bills.

Tests done by the U.S. Centers for Disease Control and Prevention and state labs aren’t being billed to patients. But as private labs, such as Quest Diagnostics and LabCorp, and academic medical centers begin offering tests developed by private partners, it’s less clear who will foot the bill.

The U.S. Centers for Medicare and Medicaid Services said that Medicare and Medicaid will cover coronavirus testing when ordered by a doctor.

America’s Health Insurance Plans (AHIP), which represents major private insurers, has also committed its members to covering coronavirus testing when ordered by a doctor.

Independence Blue Cross, the Philadelphia area’s largest private insurer, separately said it would cover coronavirus testing when ordered by a doctor and performed at an approved hospital or laboratory. The insurer will also waive any related cost-sharing for members in fully insured plans, employer-sponsored plans, Medicare Advantage plans and individual plans sold through healthcare.gov.

Self-funded employer plans managed by Independence can opt out.

Self-funded employer plans are used by large companies that pay out medical claims directly, instead of buying a private plan, and cover more than a quarter of Pennsylvania residents.

“Given that the test is new and specific billing codes for commercially available tests were only recently designated, members should report any concerns about claim payment to our customer service staff at the number on their member card,” said Richard L. Snyder, chief medical officer for Independence Blue Cross, in a statement.

UPMC Health Plan, Highmark, Cigna and Aetna have made similar commitments.

Several states, including New York and Washington, have ordered insurers to waive testing costs, though self-funded plans are exempt because they are regulated by federal law, not states.

Insurance regulators in Pennsylvania and New Jersey have not taken this step, but said they are aware of the potential cost to consumers, now that coronavirus cases have been identified in both states.

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“The Department is currently reviewing all available options to improve access for New Jersey residents to COVID-19 testing and treatment,” said Trish Graber, a spokesperson for New Jersey’s Department of Banking and Insurance, in a statement.

Pennsylvania Insurance Commissioner Jessica Altman said she has been in touch with insurers, and any order from the state will depend on what actions insurers take on their own.

“We are aware that insurance coverage is a critical piece of making sure treatment is sought and received, and that testing is done in Pennsylvania,” Altman said in an interview.

Have you gotten a bill related to coronavirus testing or treatment? We want to hear from you. Email sgantz@inquirer.com.