More than half a year after COVID-19 emerged as a major threat to Coloradans, a big question remains surrounding a key element in the war against the disease: testing, and whether it should be free.
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For private insurance regulated by the state of Colorado, insurance companies are required to cover costs for visits to an in-network provider office, an in-network urgent care center, an emergency room and non-traditional care settings where licensed health care providers are administering the COVID-19 testing.
Insurance companies must also cover out-of-network providers if an in-network provider is not available, said Vincent Plymell, assistant commissioner for the Colorado Division of Insurance.
“But keep in mind that facilities are not required to accept insurance, so smaller clinics and pop-up testing sites may very well not accept insurance and require cash payment. In these cases, a person will need to submit a claim to their insurance company for reimbursement — normally something that the doctor’s office or hospital does,” Plymell said.
If Coloradans run into problems — doctors or facilities not covering testing without out-of-pocket costs — they should contact their insurance company and the Colorado Division of Insurance, Plymell said. The public can call 303-894-7499 or 1-800-930-3745.
For questions from Medicaid or Medicare members, the Colorado Health Care Policy Department may have answers at 303-866-2993.
Coloradans can find a list of locations and contact information for where to get tested here.
Coloradans should contact the individual locations for information about any insurance requirements or eligibility.
More than half a year after COVID-19 emerged as a major threat to Coloradans, a big question remains surrounding a key element in the war against the disease: testing, and whether it should be free for everyone.
Widespread confusion over whether getting tested for the virus is free has continued months after Congress appeared to put the question to bed with two laws in March, and questions have still lingered this summer as to when the public may be hit with unexpected costs.
Some health insurance offered by Americans’ employers — known as self-funded or self-insured health plans — have refused to pay for COVID-19 tests at all or have required that consumers pay some costs, according to a letter from congressional Democrats to federal officials in July.
That’s despite the fact that federal guidance issued in late June appeared to affirm that insurers refusing to pay for tests for those with COVID-19 symptoms, or who had recent exposure to COVID-19, is unlawful. Self-insured plans must cover services related to testing, according to the June 23 guidance by the federal Departments of Labor, Health and Human Services, and the Treasury.
But that guidance served up another complication: A rule that COVID-19 testing for employment purposes — such as when a workplace requires tests before employees return to work — are not required to be covered. Neither is testing under proactive public health efforts to better understand how the coronavirus is spreading.
Colorado officials have, at times, been quick to paint the cost of testing as simple. “Testing is free,” a March 10 state news release said.
“Whether you have Medicaid or Medicare or private insurance or no health care insurance, cost is not a barrier — there is no copay, there is no out-of-pocket for testing,” Gov. Jared Polis said at a May 18 news conference.
The reality is more nuanced, although many insured Coloradans — if not the vast majority — should be able to undergo testing without costs if they have symptoms or if they believe they have been exposed to COVID-19. Uninsured Coloradans can also access free testing depending on where they seek the service.
On Aug. 11, Polis announced the opening of two new drive-up sites for free public testing at the Aurora Sports Complex and at Hyland Hills Water World in Federal Heights, joining the existing site at Pepsi Center. At press time yet another site was expected to be announced south of Denver.
In making the announcement, the governor said fast testing will be the key to stopping the virus’ spread and returning Colorado to normal. “We know that our success against this virus relies on information,” Polis said. “This is a war and intelligence is critical, knowing where the enemy is and if you are in danger.”
In their July 7 letter, congressional Democrats cited a report by Kaiser Health News, a nonprofit news outlet that covers national health policy.
Many Americans are covered by self-funded plans, where an employer’s money pays the claims, KHN reported. It may not be clear to employees that they are in such a plan, the outlet added.
Many of the companies with those plans have operated as if they’re exempt from the federal rules, the outlet reported May 22.
The U.S. Labor Department, which regulates self-funded health plans, could not immediately be reached for comment on whether self-funded plans are widely refusing to pay for COVID-19 tests or requiring consumers to bear part of the cost in Colorado and other states.
The Colorado Division of Insurance didn’t have information on that question because of its lack of authority over self-funded plans, Vincent Plymell, the division’s assistant commissioner, told Colorado Community Media.
“Knowing the varied nature of employers (and) self-funded plans, it is likely that their approach to these situations is also varied,” Plymell said.
Under the Families First Coronavirus Response Act — passed by Congress in mid-March and amended by the Coronavirus Aid, Relief and Economic Security (CARES) Act — health care coverage must generally provide COVID-19 testing and the health care office visits that ultimately result in a test, without any cost-sharing. That’s a term that means the costs consumers pay out of their own pockets, including deductibles, copayments and coinsurance.
The federal June 23 guidance says both insured and self-insured group health plans are required to comply with those requirements.
That federal guidance says the requirements don’t apply for testing for employment purposes or testing as part of certain public health data-gathering about the pandemic.
“Clinical decisions about testing are made by the individual’s attending health-care provider and may include testing of individuals with signs or symptoms compatible with COVID-19, as well as (individuals without symptoms) with known or suspected recent exposure” to the coronavirus, the federal guidance says.
It adds: “Testing conducted to screen for general workplace health and safety, such as employee ‘return to work’ programs,” or for public health surveillance for the coronavirus, “is beyond the scope” of the law.
Congressional Democrats — Reps. Frank Pallone Jr. of New Jersey, Robert Scott of Virginia and Richard Neal of Massachusetts, and Sens. Patty Murray of Washington and Ron Wyden of Oregon — took issue with that interpretation.
“We find the administration’s revised guidance deeply concerning as it appears to be a change that is without basis in the plain language of the statute,” the lawmakers wrote in the July 7 letter. They added: “Widespread testing must be in place to detect and stop the spread of COVID-19, and ensuring safety in the workplace is critical.”
As of Aug. 6, the Colorado Division of Insurance didn’t know if some private insurers stopped fully covering all consumer costs for testing required by a workplace or for public health surveillance purposes, Plymell said.
The rub over public health data-gathering may be moot in Colorado, according to the state public-health department.
“We do several different types of surveillance testing to understand the burden of disease in Colorado — none of those samples are billed to private insurance,” the Colorado Department of Public Health and Environment said in a statement. “The costs of analysis are captured by public health funding for public health surveillance programs. For example, we take a systematic sample of specimens that test negative for influenza and test them for COVID at the state lab.”
The Colorado Division of Insurance estimates that one-third of Coloradans’ health insurance plans are ones the division regulates; one-third are self-funded plans that the division doesn’t regulate; and one-third are public plans, such as Medicaid, Medicare and those of the U.S. Department of Veterans Affairs, according to Plymell.
People with any kind of private health insurance should have free access to the COVID-19 test — along with health care provider visits associated with getting the test — with no co-pays, deductibles or co-insurance charged, according to the state insurance division.
Under the division’s emergency regulation, that’s true not only if a doctor recommends a test but also if a person feels they have symptoms and they need to get tested, Plymell said.
And if a person is asymptomatic but is told by their health care provider that it is medically appropriate to be tested anyway, the test and visit should be covered with no cost-sharing.
“Being exposed to COVID-19 or believing one had been exposed would be the likely scenario why a provider would deem a test medically appropriate if the person was asymptomatic,” Plymell said. Other reasons would likely be on a case-by-case basis.
But Coloradans likely wouldn’t be covered without cost-sharing “if someone is asymptomatic and they think it would just be a good idea to get a test,” Plymell said.
Coloradans should check with their health care provider to be sure of costs.
For Coloradans with Medicare, all of the costs are covered if a doctor orders a COVID-19 test, according to the U.S. Centers for Medicare and Medicaid Services.
Under Colorado’s Medicaid program — Health First Colorado — and the Child Health Plan Plus (CHP+), all the costs of testing and the doctors’ visits associated with getting tested are covered, according to the Colorado Department of Health Care Policy and Financing.
Tests for Medicare and Medicaid members must be ordered by the member’s doctor or other health care provider, said Marc Williams, spokesman for the department.
“Medicaid will cover the test at 100% provided the patient is enrolled in Medicaid and the provider is also a Medicaid-enrolled provider,” Williams said.
Medicaid members can locate enrolled providers through the “find a provider” page at healthfirstcolorado.com/find-doctors, according to Williams.
The Veterans Affairs website says testing is based on many factors, including the severity of symptoms, other existing illnesses or conditions, possible exposure and other criteria. VA health facilities have been testing veterans who meet the testing criteria provided by the federal Centers for Disease Control, the site says. There’s no charge for testing, according to the VA.
A government program to reimburse health care providers and facilities for testing and treatment of COVID-19 for uninsured individuals provides funds to eligible providers, said Scott Kodish, a spokesman for the federal Health Resources and Services Administration.
Health care providers can request reimbursement and will be reimbursed generally at Medicare rates, subject to available funding, Kodish has said.
For those served by those providers, there are no charges to uninsured patients.
An online CDC page lists health care providers who have agreed to the terms of the program and received reimbursement for COVID-19 testing of uninsured individuals.
Uninsured Coloradans should contact the state Health Care Policy Department at 303-866-2993 to ask about options. To apply for Medicaid and Child Health Plan Plus, see this site.
Some of Colorado’s dozens of local testing sites did not list a recommendation for a doctor’s note for testing in May.
Coloradans should contact the state public-health department or the sites themselves for questions about insurance and other requirements they may have for getting tested.
Find the list of testing locations and contact information here.
After months of limits on who has priority for testing, the state announced in May that test capacity had grown to include members of the general public with symptoms. Asymptomatic Coloradans could also be tested at some locations, according to testing sites’ information at the time.
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