Insurance companies waive COVID testing coverage by shutting down pharmacies

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ALBANY – Those pesky nasal swabs remain in high demand, but the days when people don’t have to worry about paying for a COVID test are slowly coming to an end.

This is because insurance companies have withdrawn the comprehensive coverage they previously offered. This means that some people may have additional charges while some pharmacies bear the cost of administering and analyzing COVID tests for their customers.

The Central Avenue Pharmacy in Albany offers four tests: free rapid antigen, regular polymerase chain reaction (PCR), rapid PCR, and antibody tests. They distribute rapid antigenic tests, provided free of charge by the government. But the pharmacy is not reimbursed for the performance and analysis of the tests.

Sarah Walton, director of pharmacy operations, said they try to charge health insurance companies to help cover their administrative expenses, but many companies refuse to pay, leaving the overall expenses to them. -work.
She said that even if they are refused, they continue to provide the test to patients for free.

Rapid PCR tests, however, cannot go through insurance, so all patients must pay a flat fee of $ 120 for the exam.
Standard PCR tests are billable to insurance and eligible for government reimbursement for uninsured patients. But if an insurance company denies coverage for the test, the lab can charge up to $ 150 for it.

The endemic nature of the virus and its variant progeny have resulted in a high demand for testing as people are exposed. Marra’s Pharmacy in Cohoes has seen an increase in demand for testing last month, bringing in 20 to 30 people per day.

Students exposed to COVID, for example, must self-isolate and take a PCR test before returning to school. For parents whose insurance has retracted test payments, this potentially means taking money out of your pocket to pay to cover the cost.

Insurance pays for tests when patients prove they are medically necessary

According to Dr Jonathan Halpert, owner of Priority One Urgent Care at Guilderland, several insurers who have waived universal testing coverage only really pay for tests when a patient’s circumstances match their definition of what is medically necessary. .


He found that insurance will likely cover tests when ordered by a doctor during an office visit for treatment, even admitting that this is not guaranteed.

“If people show up to request a test for a reason that is not a visit to the doctor’s office … health insurance payers will not reimburse for these services,” he said, which would result in the emergency care billing.

Priority 1 is currently providing testing for people without acute symptoms who request testing for the virus, although these reasons typically “do not meet the criteria for formal medical assessment,” leaving patients open to bills.

“Health insurance does not currently cover acquisition / administrative costs for elective COVID-19 testing, which requires an upfront payment to help pay for it,” Priority One says on its website.

The office charges $ 65 for PCR tests and $ 150 for rapid antigenic tests performed without reimbursement by insurance.

Independent drugstore results not skyrocketing

Tom D’Angelo, president of the Pharmacists Society of New York State, said it’s important to note that pharmacies and emergency care facilities operate differently. Pharmacies have a harder time finding reimbursements for tests.

Emergency care has test codes built into their contracts with insurance companies giving them access to billing. Pharmacies don’t have this because it was only recently – under a pandemic-induced executive order – that they became limited-service labs with testing powers. In addition, the type of billing used by pharmacies is not compatible with that of testing, D’Angelo explained.

The decree recognizing pharmacies as limited laboratories has since expired, but a clause in the federal law on public preparedness and emergency preparedness allowed them to continue their efforts.

Walton confirmed, noting that most insurance plans will advertise coverage for coronavirus testing, but will only pay specific providers, doctors or emergency care facilities, not pharmacies. She added that the companies also exclude pharmacies from registering as providers on the medical side, preventing them from being billed for the service.

“It’s just unfair,” she said. “Insurance should pay for the service. It is an indispensable service.

Walton took it upon herself to contact the insurance companies and ask them to cover the tests or change their policies. She’s been unlucky and looks at a long list of non-paying vendors.

“For pharmacies, even if we have tried very hard to be there for our neighborhoods, for our communities … it takes time, it takes money, it takes effort, and we are not really reimbursed properly for that “, says Angelo.

“Unless you charge cash at the pharmacy, you lose money and it hurts results,” he added.

Both Marra’s and Central Avenue Pharmacy saw an increase in their revenues directly related to the tests. Yet with more testing, the need for additional technicians and manpower was deducted from their profits.

The Central Avenue Pharmacy reported a “two-fold” increase in revenue, but a “four to seven-fold” increase in workload. Around the same time last year, Walton said they were successful with one or two techs. Today, the operation requires seven people to keep things running smoothly, which they paid for.

The tests provided enough to pull the pharmacy out of the financial hole it fell into in 2020 and stabilize itself.

John McDonald III, a former owner of Marra still involved in the business, has moved away from seeing the tests as profitable. He estimated that insurance reimburses $ 17.43 per test. Factor in the $ 10 processing fee, and the pharmacy has $ 7.43 to play with before calling a technician to take care of the rest.

“You can see where it doesn’t work. It’s something that when you factor in staff time, we cover our costs, ”said, who is a Democratic Assembly member representing Cohoes and parts of Albany.

“We got into this because the state asked us to. What we do is build goodwill with our patients.

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