Over the past few weeks, we’ve been receiving questions about the various types of COVID-19 tests that are currently available and how they will be covered going forward, particularly as organizations formalize return-to-work plans. We hope the following information adds clarity to this issue for you.
The central question is this: Are diagnostic tests for COVID-19 covered without a copay, coinsurance or a deductible?
The answer to this question is “yes” IF the test:
- Has been approved by the Food & Drug Administration (FDA) (or there’s a pending request for approval)*
- Has been ordered by a physician
- Is medically appropriate for the individual
- Is for diagnostic purposes
Tests that do not satisfy these requirements are not required to be covered without member cost-sharing under the coronavirus aid bill. Testing to screen for general workplace health and safety (such as employee return-to-work programs), testing for public health surveillance or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19 or another health condition does not qualify.
Let’s look at some common scenarios and answer the question of whether COVID-19 tests would be covered without member cost-sharing?
- Members who have symptoms of COVID-19
- Members with high-risk exposure (as defined by CDC guidance)
- Members checking to see if they are free of the virus after a positive test
- Members who have no COVID-19 symptoms or high-risk exposures, but are curious about whether they have COVID-19 (or have had it in the past)
- Symptom-free employees without high-risk exposure who are tested so they can return to their workplace
Questions? Contact your Arkansas Blue Cross representative, and we’re happy to help.
* Diagnostic COVID-19 tests approved by the FDA include: Amplified nucleic acid (e.g. RT-PCR) tests and Antigen** tests
** While both antigen tests and RT-PCR tests are covered by insurance, antigen tests cannot be used to rule out COVID-19 as a stand-alone. Therefore, RT-PCR is the preferred testing method by the medical directors at Arkansas Blue Cross for the safety of our members.