OTC COVID Test Reimbursement Woes
April 2, 2022 2:49 PM Subscribe
Is anyone else getting the runaround from insurance on reimbursement for over-the-counter COVID tests? Do you have any hacks for actually getting reimbursed?
I bought 4 over-the-counter COVID rapid tests from a major pharmacy chain (2 boxes of 2 tests each). I submitted a claim for reimbursement with Anthem CA (PPO, if that matters).
First, they denied the claim on the grounds that "no service date was provided." So I called them and spoke to a (very nice!) rep who said the receipt photo I uploaded clearly provided all the information required for the claim. She initiated some kind of manual review to force a human to look at it. (Apparently the first pass review is entirely automated, and the machine couldn't "see" the purchase date.)
A few weeks later I received an email that a check was on the way. But when I logged into Anthem's site to review their Explanation of Benefits, it said they were only reimbursing HALF the overall cost because the major pharmacy chain was "out of network." So I called them again, and a rep said they were sending my claim back for a "second review."
I know insurers are generally garbage, but has this been everyone's experience with the test reimbursement process? And if not, what are you doing to get reimbursed and can you explain it to me so I can do it too? Should I be submitting PDFs instead of JPGs? Do insurers prefer certain retailers over others? How do you figure out if a retailer is "in network?"
Also, when the first check arrives, can I deposit it or do I have to hold it until Anthem makes a ruling (that is, would depositing it constitute an implicit acceptance of their clear attempt to sidestep the federal requirement that they pay for the damn tests)?
I bought 4 over-the-counter COVID rapid tests from a major pharmacy chain (2 boxes of 2 tests each). I submitted a claim for reimbursement with Anthem CA (PPO, if that matters).
First, they denied the claim on the grounds that "no service date was provided." So I called them and spoke to a (very nice!) rep who said the receipt photo I uploaded clearly provided all the information required for the claim. She initiated some kind of manual review to force a human to look at it. (Apparently the first pass review is entirely automated, and the machine couldn't "see" the purchase date.)
A few weeks later I received an email that a check was on the way. But when I logged into Anthem's site to review their Explanation of Benefits, it said they were only reimbursing HALF the overall cost because the major pharmacy chain was "out of network." So I called them again, and a rep said they were sending my claim back for a "second review."
I know insurers are generally garbage, but has this been everyone's experience with the test reimbursement process? And if not, what are you doing to get reimbursed and can you explain it to me so I can do it too? Should I be submitting PDFs instead of JPGs? Do insurers prefer certain retailers over others? How do you figure out if a retailer is "in network?"
Also, when the first check arrives, can I deposit it or do I have to hold it until Anthem makes a ruling (that is, would depositing it constitute an implicit acceptance of their clear attempt to sidestep the federal requirement that they pay for the damn tests)?
Best answer: CVS will run the tests through your insurance and fill them like a prescription, so you know if they are covered and that they will be paid for in advance, rather than waiting to be reimbursed. I was skeptical but the process was incredibly painless for me.
posted by telegraph at 4:27 PM on April 2, 2022 [4 favorites]
posted by telegraph at 4:27 PM on April 2, 2022 [4 favorites]
I called my insurance for information about what form to use for reimbursement and they flat-out said they don't do that (even though they're supposed to) and that I need to have them billed to insurance at the pharmacy. I have done this successfully at CVS, you go up to the pharmacy counter and they handle it. The only wrinkle I know of is that not every brand of test will be covered this way, and if they're out of the tests that are you might be out of luck.
posted by needs more cowbell at 4:59 PM on April 2, 2022
posted by needs more cowbell at 4:59 PM on April 2, 2022
I also did this today at a Rite Aid, and it was also apparently limited to one brand even though they had two brands in stock. It was easy to do although it took the pharmacy tech about 5 minutes to work through the various data entry points.
Previously I submitted a claim to my insurer through a hard to find claim link, they never acknowledged it, but I received a check for the full amount about 6-7 weeks later. This was for an online purchase through Walgreens.
posted by happy_cat at 6:37 PM on April 2, 2022
Previously I submitted a claim to my insurer through a hard to find claim link, they never acknowledged it, but I received a check for the full amount about 6-7 weeks later. This was for an online purchase through Walgreens.
posted by happy_cat at 6:37 PM on April 2, 2022
Best answer: You have two additional escalation paths, especially if they're flatly refusing to do a required thing. You can tell your insurer you'd like to file a grievance, or you can Google something like "health insurance regulator (your state here)" and find out how to file a complaint. As I understand it, there complaints are taken very seriously.
posted by lorimt at 8:11 PM on April 2, 2022
posted by lorimt at 8:11 PM on April 2, 2022
My husband bought tests from Amazon, and my Blue Cross declined the submission. I didn’t bother chasing after the $40.
My insurance company is partnering with Express Scripts, though, so I was able to get 8 tests per household member shipped to me for free through them. That was east and worked well except for the three weeks wait.
posted by leahwrenn at 9:42 AM on April 3, 2022
My insurance company is partnering with Express Scripts, though, so I was able to get 8 tests per household member shipped to me for free through them. That was east and worked well except for the three weeks wait.
posted by leahwrenn at 9:42 AM on April 3, 2022
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posted by phunniemee at 3:01 PM on April 2, 2022 [1 favorite]