This report is by Andrew Perez.
As businesses reopen, laid off and furloughed workers will lose access to unemployment benefits if they stay home out of fear that their workplaces are unsafe. Now, a move by the Trump administration to protect health insurance profits may force workers to fork over money for the privilege of being forced back to jobs that jeopardize their lives.
Many businesses want their workers to be screened for the virus before returning to workplaces, where they could unknowingly spread the disease to co-workers and customers. But thanks to a new Trump administration guidance, if businesses do require their employees to undergo coronavirus tests before being rehired, employers or their employees -- not health insurers -- could end up paying for it.
The directive comes as insurers have been pushing for relief from testing mandates -- and it is a potential jackpot for the industry, whose profits are already booming during the pandemic. It’s an extra kick in the ass when some states have enacted liability protection measures blocking employees and customers from suing businesses if they are infected with COVID, and Congress is weighing the idea nationally, too.
Last week, Trump officials issued the guidance declaring that health insurance companies are not required to cover the costs of COVID-19 testing for employment purposes under the Families First Coronavirus Response Act. The legislation was passed by Congress to prevent patients from dealing with copays or out-of-pocket costs for coronavirus tests.
The new guidance provided by the U.S. Labor Department, the Department of Health and Human Services, and the Treasury Department says that insurers only need to pay for tests that are determined to be “medically appropriate” by a health care provider.
That loophole could allow insurers to avoid covering the costs of back-to-work tests. The bills will likely fall on businesses -- or workers, if their employers don’t want to pay. The costs of tests can be quite expensive, ranging from about $150 all the way up to $7,000, according to Politico.
America’s Health Insurance Plans, a lobby for major health insurers in D.C., recently commissioned a study showing that COVID testing costs could add up to between $11 billion and $44 billion a year. That’s potentially a big enough sum to affect insures’ profits, even as they save money from people avoiding medical care and elective procedures as much as possible. Insurers have also objected to covering coronavirus antibody tests, arguing that they are too unreliable.
“Now I Have A Bill For The COVID-19 Testing”
The administration’s decision follows a series of inexplicable comments that President Donald Trump has made in recent weeks suggesting that he personally instructed his “people” to slow down coronavirus testing. Last week, the Trump administration also announced that it is ending federal support for coronavirus drive-thru testing facilities in five states that have been hit particularly hard by the pandemic.
“Nursing homes will be among those most impacted by the new testing coverage guidance,” according to Modern Healthcare, since employees at many nursing home facilities are required to undergo regular COVID-testing. The Wall Street Journal reported earlier this month that there have already been more than 50,000 deaths tied to nursing home facilities since the pandemic started. According to the New York Times, nursing homes don’t want to pay for the tests, either.
Eye doctors’ offices are another workplace where social distancing between patients and doctors isn’t realistic. In April, an optometrist in Seattle wrote to the Washington State insurance commissioner requesting that her insurer, UnitedHealthcare, cover her back-to-work test, according to a consumer complaint obtained by TMI.
“I was required to have COVID-19 testing due to a cold prior to lockdown in order to go back to work, and now I have a bill for the COVID-19 testing,” she wrote. “This bill should be waived as both my insurance as well as the state have waived all fees regarding COVID-19 testing."
The insurance commissioner’s office told her they couldn’t help her because she is on a self-funded plan -- like many people with employer-based health insurance coverage -- that’s regulated by the Labor Department. Now, the Labor Department has made clear that her insurance company won’t have to pay.
Other Loopholes That Help Insurers Avoid Covering Tests
There are other loopholes in the Families First Act’s requirement that insurers cover coronavirus tests and treatment.
For example, if a patient visits a doctor’s office believing they may have coronavirus and their doctor doesn’t order a test, they can be billed for the office visit, as a consumer complaint from Washington state about Regence BlueCross BlueShield of Oregon makes clear.
"In early March, my child... had a cough,” a parent wrote. “Her high school requested that I take my daughter to the doctor for COVID19 testing before she could fully return to school activities. In reliance on the OIC Emergency Order No. 20-21, we went to Pacific Medical Center's Lynnwood office for COVID-19 testing and treatment. Pacific Medical Center did an exam for COVID-19 and determined that my daughter was not in a high risk category that necessitated laboratory testing. Regence did not waive the deductible and now Pacific Medical Center is billing me $203.35 for the office visit."
A lawyer for Regence said that the services billed “only encompassed an office visit.” She explained: “Claims for office visits are payable at 100% if a COVID-19 test has been billed or the office was billed with a diagnosis that indicates a positive COVID-19 test.”
Some hospitals have complained that large employers with self-funded health insurance plans have been operating under the assumption that they aren’t covered by the Families First Act and don’t have to pay for coronavirus testing at all -- even after the Labor Department clarified in April that the law does in fact apply to self-funded group health plans.
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