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Major Insurer Claims It Has No Obligation to Pay for Pooled COVID-19 Testing

Free COVID-19 testing is a powerful and very compelling policy. The problem, of course, is that somebody has to pay for coronavirus testing. And the insurance companies have been designated as that somebody. However, loopholes in the free testing mandate imposed on insurers are starting to emerge, first with regard to coverage of employer workplace screening tests and now on the issue of sample pooling.

The Free Testing Mandate & the Loophole

The starting point in the recent controversy is a piece of federal relief legislation called the Families First Coronavirus Response Act (FFCRA) which requires insurers to pay for COVID-19 tests without imposing any copayments, deductibles, coinsurance or other cost-sharing. Technically, the requirement, i.e., Section 6001 of FFCRA) applies only to tests that a healthcare provider deems “medically appropriate.”

The “medically appropriate” language has been turned into something of a loophole to get around the free testing mandate. However, it was not the insurers but the Administration that created it. On June 23, the Departments of Labor, Health and Human Services (HHS) and Treasury issued joint guidance (FAQ 5) clarifying that Section 6001 does not apply to “testing conducted to screen for general workplace health and safety (such as employee “return to work” programs, for public surveillance or any other purpose not primarily intended for individualized diagnosis or treatment of COVID-19.”

The Controversy Over Sample Pooling

And now insurance companies are attempting to use the loophole to avoid paying for sample pooling. Explanation: Pooling is a technique that involves mixing aliquots, i.e., sub-samples extracted from individual samples into a pool or “batch” that can be tested with a single test. If the entire pool returns a positive result, the individual samples must be retested to locate the source of the positive; but if the batch tests negative, all of the constituent samples are also deemed to be negative.

Sample pooling has been hailed as a way to increase COVID-19 testing capacity while conserving precious supplies. In July, the U.S. Food and Drug Administration (FDA) for the first time ever authorized existing assays with Emergency Use Authorization (EUA) from Quest Diagnostics and LabCorp for sample pooling use. More sampling authorizations are expected to follow.

However, at least one of the country’s biggest insurers has made it known that it wants no part of paying for pooled testing. Citing the joint guidance, Cigna claims that pooled tests are “screening” assays and that the free test mandate applies only to individual diagnostic tests.

The Blowback

Cigna’s determination that it does not have to pay for pooled COVID-19 testing has not sat well with a number of health care organizations, including the American Clinical Lab Association, The American Hospital Association, and The Association of American Medical Colleges. The topic may also come up as part of a new Democratic led effort in the U.S. House of Representatives to look into the outsized profits that insurers are reportedly making during the pandemic.

Takeaway

Cigna seems to be out on an island. As of press time, we know of no other major insurer that has made a similar pronouncement about not paying for pooled COVID-19 testing. Meanwhile, insurers and laboratories have asked Congress to create a national testing fund to pay for COVID-19 testing. But so far, Congress has made no moves to advance any such legislation to cover these testing costs.  


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