Independent pharmacies tussle with insurers over COVID test payments

Independent pharmacies tussle with insurers over COVID test payments

“It would be nice if we could have some consistency,” Moore said.

The federal and state governments require insurers to cover diagnostic COVID-19 testing without cost-sharing, including at pharmacies. That includes tests for patients who are asymptomatic and who have no known or suspected exposure to the virus; plans are not supposed to use medical screening criteria to deny coverage of tests.

“It is imperative for the health and safety of all New Yorkers to have broad access to COVID-19 infection and antibody testing, including testing performed at a pharmacy,” Lisette Johnson, chief of the state Department of Financial Services’ health bureau, wrote in a May 2020 letter to insurers.

The U.S. Department of Health & Human Services last year issued guidance authorizing qualified pharmacy technicians to administer COVID tests and COVID vaccines, noting that pharmacies are “well positioned to aid COVID-19 testing expansion.”

But insurers maintain differing policies on which tests are covered and when, as Crain’s has previously reported.

Ambar Keluskar, a pharmacist at Rossi Pharmacy in East New York, Brooklyn, said almost all insurers have denied his claims for COVID specimen collection fees, with the exception of some Medicaid managed-care plans. Insurers say the service is not covered or that the pharmacy is an invalid location, Keluskar said. Pharmacies like his rely on the reimbursements to cover labor costs; the Medicare rate for specimen collection is just over $23. (Laboratories process the tests and bill separately.)

“They’re supposed to be paying for these services, but they’re just choosing not to,” he said.

Rapid tests that pharmacies both administer and analyze are more of a gamble, he said, because the costs are higher, and claims may not be adjudicated for weeks.

Leslie Moran, senior vice president of the New York Health Plan Association, which represents 28 insurers in the state, said insurers are not disputing that pharmacists can administer COVID tests. Moran attributed the issue in part to improper billing and said plans have been working with pharmacies to correct medical-coding errors.

“It’s frustrating on both sides to have this be an ongoing problem,” she said.

Moran also noted the distinction between testing for diagnosis of COVID-19 and broad-based testing for reasons like travel or going back to school.

Rejected claims can always be disputed, Moran added. Pharmacists noted that’s easier said than done.

“It’s practically a full-time job chasing down insurers to get paid,” Keluskar said.

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