Buying a COVID test is easy enough. Getting reimbursed for it is another story.
After coming home from a weekend trip with friends last month, I purchased a test online to have one on hand in case I got sick, as I’ve done throughout the pandemic. But this was the first over-the-counter test I’d bought since the Biden administration announced that health insurers would have to cover the cost of up to eight OTC tests per month, up to $12 per test, through the end of the COVID national emergency.
I submitted the receipt to my insurer, Anthem, which took less than 15 minutes to get through the process. When I submitted my claim, I was greeted with a message saying it would be reviewed—within 30 to 45 days. My claim was approved faster than that, but the money still hasn’t hit my account, and I’m not sure when it will.
The administration’s new reimbursement requirement was announced after weeks of public outcry over the scarcity of both PCR and over-the-counter antigen tests, as the Omicron wave was spiking case numbers and hospitalizations beyond any other point during the pandemic.
It was also rolled out as part of a series of moves from the administration to expand testing, which included making 500 million free at-home tests available to order online through the U.S. Postal Service. During his State of the Union address Tuesday, Biden announced that starting next week, households that have already received four free tests from the government will be able to order more.
But more than a month since the reimbursement rule was implemented and insurers had to begin paying for over-the-counter tests purchased at pharmacies and other retailers, some of their enrollees are still struggling to figure out how to get their money back.
Kate Kelley, a 47-year-old from the Toledo, Ohio area who is insured through her employer with Aetna, purchased a test from Rite Aid on January 17, two days after the Department of Health and Human Services rule went into effect. “I heard the news that they were offering the free at-home tests available at pharmacies,” Kelley told VICE News. “[The pharmacist] said that at this point, you have to pay for it and submit the reimbursement to your healthcare provider.”
“Okay, not too hard,” she remembered thinking at the time.
But after more than a month, Kelley still hasn’t been able to figure out how to submit her COVID test to be reimbursed, she told VICE News. At first, she said, Aetna’s website had a message asking enrollees to “stand by” while the company issued guidance.
But then, she said, the guidance sent her into a “loop” between different pages on Aetna’s website and external links to government websites, and she still hasn’t been able to figure out how, exactly, to submit her reimbursement claim. She’s complained on social media, but still hasn’t figured out a way to submit her test. “I’ve been sitting on that receipt for a while,” Kelley told VICE News.
“This should be a lot more straightforward,” she said of the process. “It's occupying a lot of time wasted on a website, going in circles without getting a clear answer.”
The process for submitting a claim varies wildly from insurer to insurer. An analysis of 13 insurers by the Kaiser Family Foundation (KFF) when the rule was implemented in January found that fewer than half were offering direct coverage of COVID tests, meaning that if you get a test from a retailer or pharmacy approved by your insurer, there are no upfront costs.
Since then, only one of the seven companies that didn’t offer direct coverage—Blue Cross Blue Shield of Michigan—has begun offering direct coverage of COVID tests, according to KFF director of LGBTQ health policy Lindsey Dawson, who worked on the KFF review.
At the time of the KFF review, four insurers required the person purchasing the test seeking reimbursements to print out, complete and mail a form along with a receipt to get reimbursed, and three also required the test’s universal product code (UPC). One insurer, Cigna, had a three-page form that the user had to mail or fax—an obsolete piece of technology for most Americans which remains stubbornly relevant in American medicine.
“Some of them definitely have more cumbersome approaches,” Dawson told VICE News. “The companies that require somebody to include the proof of purchase or UPC code or barcode on their test box, along with the receipt and filling out a form and potentially getting that by mail, definitely requires more legwork than being able to use your smartphone to upload everything online.”
Dawson is insured by Cigna, and said there’s an option to submit a claim online. But after trying to submit a claim, she said the claim didn’t appear in her online profile. She attributed this to forgetting to hit a “submit” button at the end.
“The consumer really has to navigate their insurance company’s policies to take advantage of them,” Dawson said. “[I’m] somebody who’s been researching these practices…even I seemed to fail to complete that last step.”
For some, the timing of the rule complicated their eligibility. Biden said in a December 2 speech that the administration would require private health insurers to reimburse their enrollees for COVID tests beginning in January. But the regulation itself wasn’t announced until January 10, and wasn’t implemented until January 15.
Vasil Pendavinji, a 27-year-old from Waltham, Massachusetts, ordered several boxes of rapid tests online after traveling with their partner for the holidays and finding it impossible to book a PCR test. They still haven’t been reimbursed for the tests by Cigna, and believe that the reason for that is that they ordered the tests on January 5, even though the tests didn’t actually arrive until January 19.
“It was not clear what dates the coverage was going to start,” Pendavinji said. “It’s not clear at all on Cigna’s website, they don’t list anything.”
Because the reimbursement is happening through private insurers rather than a government agency, there’s little in the way of data on how many people have successfully used the system or how many tests have been reimbursed. VICE News reached out to several major national insurers, including Cigna, Anthem, and Aetna, asking about their reimbursement process and if they had gathered data on the number of reimbursements submitted; only Aetna and United Healthcare responded, and neither provided data.
An Aetna spokesperson told VICE News that subscribers can get OTC tests with no out-of-pocket cost at more than 65,000 pharmacies, and those who order tests from non-participating retailers can “submit a claim for reimbursement through the secure Aetna member website by logging on and following the instructions.”
A spokesperson for United Healthcare told VICE News that the process is “working well and we are not aware of any specific issues,” and said the list of retailers where subscribers can get a test for free includes Walmart, Walgreens, and Rite-Aid.
What little data has been made publicly available has suggested only a small number of people have actually bothered submitting claims to be reimbursed. Between January 15 and January 30, just 0.5 percent of Blue Cross Blue Shield of Massachusetts subscribers filed COVID test reimbursement claims, WBUR reported last month. (2.9 million people were enrolled in BCBS of Massachusetts plans in 2021, according to the company’s annual report.)
Also of note is that the Omicron wave peaked in the U.S. around the time insurers had to start covering the cost of the tests.
Melody, a 29-year-old from Atlanta who’s insured by Anthem, said she’s “consistently had frustrating experiences” with submitting claims to her insurer. She’s currently waiting, she said, on more than $1,000 in reimbursements for claims for out-of-network weekly counseling sessions which she said were wrongly denied by the company and later corrected.
“It feels like I never know how much anything will actually cost me, because Anthem is so inconsistent with what gets approved or denied, and how much is covered,” Melody said in an email to VICE News.
Getting reimbursed for COVID tests has been no different for her. Melody told VICE News she submitted $130 worth of COVID tests to be reimbursed in January. At first, she was only reimbursed for $70. “Even though it was easy to submit my reimbursement request, Anthem initially botched the processing of it,” Melody told VICE News in an email.
It was only after spending hours talking with Anthem online and on the phone, she said, that she was reimbursed for the full amount. When she tried to submit her claim for February, though, Anthem didn’t approve $23, meaning she had to once again chat with an Anthem representative, who told her that the claim was “processed against your deductible in error.”
Melody said the process has been so frustrating that she sometimes feels like it’s intentionally onerous. “This is, for obvious reasons, catastrophic for the well-being of our national public health.”
The number of people testing positive for COVID daily is currently less than one-tenth what it was during January’s peak. Biden sent a letter to Congress Feb. 18, however, extending the COVID emergency beyond March 1, saying “it is essential to continue to combat and respond to COVID-19 with the full capacity and capability of the Federal Government.”
This means the requirement for insurers to reimburse enrollees will continue for the foreseeable future. And although tests are abundantly available now, as COVID case numbers are currently as low as they’ve been since before the Delta wave last summer, the unforeseen Omicron wave serves as a lesson that demand for tests could come roaring back with the arrival of new variants or with waning immunity.
Melody said she’ll keep trying to get reimbursed as long as the option is available.
“I'm grateful for the peace of mind, but I’m very frustrated about the process of reimbursement,” Melody said in an email. “I personally think it’s still worth it to try, but I know so many people who have said it’s not worth it to them to try to submit reimbursements.”
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