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At-Home COVID Test Reimbursement Success!

Today’s video recaps a laborious healthcare claims odyssey. To recap, the Biden Administration decreed that as of January 15, 2022, most Americans would be eligible for reimbursement for at-home COVID tests through their health plans. Having to cover unanticipated claims is a challenge for insurers but because this is their business, I thought it would be straightforward when I filed claims in July. It was not. The specific claim form CIGNA developed for this purpose was rejected with a footnote that claims should be submitted through the pharmacy portal which is Caremark in my case. And how many people have established online access to their prescription drug portal? I hope more do, as a result of this adventure.

And another annoying fact is that along the way, a CIGNA representative via an online chat through my CIGNA portal informed me that at-home COVID tests weren’t a covered benefit at all. Anyway, I resubmitted the claims to Caremark and I am happy to report that my husband received two checks, one for $23.99 and one for $71.97. We truly earned that $95.96.

In some ways, this experience is not a representative example of claims reimbursement challenges because reimbursement for at-home COVID tests is a unique situation related to the pandemic and will expire soon. At the same time, it is a perfect example of the frustration of dealing with our healthcare claims system and underscores why we advise again and again to shop for coverage according to your network and to work to stay in-network whenever you can. When you’re in-network, your provider submits claims and you avoid filing them altogether.

In the United States, most insurance companies are for-profit companies with strong incentives to show regular profits. One helpful tactic for most is to formalize a claims process that is less user friendly than it could be.

A final plea is to be practical. When we file claims, whether for out-of-network reimbursement, a flexible spending account (FSA) or a health savings account (HSA), or other reimbursement, we see that as money we are entitled to and for good reason. But – be practical. Stay in-network when you can to avoid filing claims altogether and when choosing what to submit to an FSA or HSA, try to submit larger items rather than pages of pharmacy copayments, for example.

And remember that there is an era in your future where these headaches largely disappear. Those on Medicare rarely deal with claims submission.

Please watch the video and thanks for watching. Spread the word.