COVID-19 Helpful Tip: Who Pays for COVID-19 Testing?

To Our Valued Clients: 
We recognize that there is plenty of uncertainty right now unfolding around the situation we find ourselves in with the introduction of COVID-19. At Diversified, our aim is to add some clarity surrounding your medical plan by reviewing the trending topics of the calls coming into our member services department.

Question #2:  Who pays for COVID-19 testing?

There has been considerable confusion over who actually is paying for COVID-19 testing. Some statements have been unclear and have given the impression that all COVID-19 testing is covered by the Government. In the case of Medicare, Medicaid, other governmental plans and the uninsured, that is true. The Families First Coronavirus Response Act gave $1 billion to the National Disaster Medical System to reimburse medical providers for testing and diagnosing uninsured patients. Medical providers are able to submit bills directly to the federal government and get reimbursed.

Private insurers will still be charged for testing and associated costs. The law requires insurers to cover testing and doctor’s office, urgent care, telehealth or emergency room visits as long as the services “relate to the furnishing or administration” of a COVID-19 test. The coverage is to be provided with no cost sharing to the member. Individuals covered under your health plan can get tested with no cost share. However, the underlying insurer is still charged for the provider’s services and the COVID-19 test. For fully-insured groups this means the insurance company, but for self-funded plans it means the plan itself.

The costs of COVID-19 testing itself will depend upon where and who performs the test. The Centers for Medicare and Medicaid recently issued several billing codes to insurers that apply for COVID-19 testing. Diversified Group has updated our claims systems to ensure that these codes are properly applied and claims continue to be paid with expediency. The situation will continue to change and develop and we will keep you updated as it does.