When I asked my insurer to pay me back for eight COVID tests, the last thing I was expecting to hear was that, actually, I owed them.
In early December — when Omicron was revving into high gear and tests were scarcer than NFTs — the White House announced that private insurance companies would reimburse customers for at-home rapid tests. “This winter,” President Biden said, “you’ll be able to test for free in the comfort of your home and have some peace of mind.”
As a cynical journalist who’s written a story or two about our healthcare system’s flaws, I doubted that getting my money back would be so easy. But even I was surprised to log on after filing my claim and discover not a check, but a bill. For $43.41, to be exact.
It was, of course, a mistake on the company’s part. And to me, it was inconsequential and frankly sort of funny. But this screw-up — which would be an unaffordable burden for many people in the US — offers a revealing glimpse into how our country’s messy COVID testing strategy made the Omicron chapter of the pandemic more chaotic and dangerous. And while Omicron seems to be leveling off, my misadventure in reimbursement makes me wonder how willing we are, collectively, to learn from the past (or, more precisely, the present, as people are still dying every day) and be prepared if or when the next Greek letter hits.
On Jan. 19, the CVS down my street got a shipment of COVID antigen tests. Because these tests provide a real-time snapshot of whether you are infected within 15 minutes, they’re handy — though admittedly not infallible — for determining whether you’re contagious. Having run out during Thanksgiving and Christmas, my partner and I ran out that day and bought a total of eight FlowFlex tests for $9.99 each. Given that we’d been holed up inside for a while, trying to avoid Omicron, procuring those tests was one of the happiest things to happen to us at the time. Which is a very sad sentence to write.
On Jan. 21, I submitted a request to my insurer — Empire Blue Cross Blue Shield, which is owned by Anthem — for the total cost plus tax, $86.82. Since the federal policy had kicked in almost a week earlier, on Jan. 15, and it covered up to eight tests per month, I figured I was in the clear. (Later, I would realize that the policy technically covered eight tests per covered member, not household, and my partner, who bought four of the tests, was not on my plan, although we were spending the same money.)
A week after I’d uploaded my claim and pictures of the two receipts, I logged in and saw that the amount to be paid by the insurer was $0. My “amount owed,” on the other hand, was … $43.41. Surely I was misreading something?
The billing codes made no sense. Half the cost, it said, was being applied to my deductible — the amount I paid for healthcare before the insurer would start sharing the costs. The other half, which I owed, was supposedly due to me seeing a doctor who “isn’t in your plan.”
Technically speaking, this wasn’t even wrong: I hadn’t seen a doctor at all.
The policy I was trying to take advantage of was one of several new efforts to increase testing, announced in early December. At the same time, the Biden administration said it would provide 50 million free tests to uninsured Americans through health centers and rural clinics. That was on top of other measures that Biden has taken since assuming office, like using the Defense Production Act to ramp up manufacturing of tests, including at-home, rapid ones. Under his watch, the number of at-home testing options has gone from zero to nine as of early 2022, and there are 20,000 free, federally supported testing sites. Most recently, during his State of the Union address, Biden unveiled a new “test to treat” strategy, where people who test positive at the pharmacist are given antiviral pills on the spot.
Still, when millions were doing their best to gather safely for 2021 holiday celebrations — for many, like me, their first in two years — there simply weren’t enough tests to go around. And until recently, the US government was unwilling or unable to give everyone free tests, as the United Kingdom was doing. Asked about the idea on Dec. 6, press secretary Jen Psaki mockingly replied: “Should we just send one to every American?”
When the White House announced that an estimated 150 million insured people could seek reimbursement, many experts worried that this policy would erect even more barriers. It’s the kind of tedious process that favors fortunate people like me: I work from home, talk to people in healthcare for a living, hoard receipts as a habit, and can afford to spare both $86.82 and hours on the phone with insurance representatives during the workday.
“It requires an individual to take a number of steps that, as your case demonstrates, can be onerous and complicated, and requires the individuals to front the cost of the tests in a lot of cases,” Lindsey Dawson, a policy analyst at the Kaiser Family Foundation, a nonprofit healthcare think tank, told me.
She added, “It’s not a perfect solution to getting a test to everyone free of charge. I don’t think anybody pretended this was that solution. It was a step in the right direction in terms of making tests more available and more affordable to more people.”
Private insurers were also encouraged to allow enrollees to order rapid at-home tests directly from them, without paying anything up-front. But as of late February, only about 7 of 13 major insurers were offering a “direct coverage” option, according to Dawson, who updated these numbers from a mid-January report upon my request. The rest were covering tests exclusively via reimbursement, with one, Kaiser Permanente, saying it was working to make tests available “through a number of outlets, including mail order.”
Ifeoma Ozoma, who lives in Santa Fe, New Mexico, has been grappling with a predicament even more Kafkaesque than mine. Ozoma is as tech-savvy as they come: she is a former Pinterest employee turned whistleblower who now runs her own consulting firm about tech policy issues, including worker protections. But after buying six Abbott BinaxNOW test kits from Walmart’s website on Jan. 24, she logged onto Blue Cross Blue Shield of New Mexico — her fiancé’s insurer, which covers her as well — and couldn’t find any information on the website for people on their plan about getting reimbursed for the $127.78.
The first representative she reached didn’t know what to do, and directed her to the company that managed prescription drugs for her plan, which wasn’t any more helpful. “The person I spoke to on the phone was really confused and she had no idea what I was talking about for reimbursement,” Ozoma said. “I was like, ‘No, this is federal law, there has to be a way for me to file for reimbursement.’ She said, ‘Uh, well, I can’t figure out where to do that, so you need to call Blue Cross.’” Back to the insurer Ozoma went.
This time, a representative dug up a pharmacy reimbursement form to fill out. It wasn’t specific to COVID tests, so the document asked for information like a medical prescription number. Ozoma filled it out as best she could and submitted it, per the employee, through an online messaging system.
When we first spoke at the beginning of February, Ozoma told me that she was beyond frustrated with the nation’s “disaster” of a testing strategy.
“We’re in a situation where the people who need the tests the most, people who are low-income, people who have large families, people who have kids, people who have to go into work, are in a situation where they simply can’t afford to pay $130 at a time for tests,” she said. “I just have a feeling that people — if you go through this experience once, and you tried to do this, and you had kids so you just don’t have as much free time as I do during the day, why would you do it again?”
As of early March, Ozoma had finally gotten paid — but only partially. She said she received a letter in the mail saying the insurer had approved part of her claim, but denied the rest. Even though she and her fiancé are on the same plan, the company told her it needed separate claims for each of them, using the same receipt — a detail that Ozoma said wasn’t made clear anywhere. She was recently waiting to hear back on an additional claim for the rest of the amount. “From now on we’ll buy tests on separate receipts and submit each as a separate claim,” she told me by email. “Such a headache for two people.”
In retrospect, it’s not surprising that she and I were having issues. Private insurance companies found out in December that they would have to reimburse for tests in the new year, but didn’t get detailed guidance about how that would work until Jan. 10. The policy took effect just five days later.
Dawson said that she expects these hiccups to get smoothed out in the coming months but acknowledged that plenty of people may get discouraged before that happens. Not Ozoma. “I am a dog with a bone on this stuff,” she told me.
It took a few calls, but eventually I figured out that my insurer had not just miscoded my purchase, but mistakenly thought that the two receipts I’d sent in were for the same set of four tests, rather than two different purchases. Once I pointed this out, the representative apologized.
After getting notified that the payment had finally been approved, I contacted Anthem, this time as a reporter. Spokesperson Jeff Blunt said by email that the company “worked quickly to develop payment processes for over-the-counter COVID-19 test kits” in response to the mandate. “Regretfully, a processing error occurred in reimbursing your January 21 claims and we are pleased that has now been corrected,” he told me. Members are currently being reimbursed within two to three weeks, he added.
Blue Cross Blue Shield of New Mexico referred me to its pharmacy benefit manager, Prime Therapeutics. Anne Mack, a senior director of network compliance, said she could not comment on Ozoma’s case and didn’t answer my questions about how long it was taking to process claims. In a statement, she said that “the reimbursement process for COVID-19 at-home test kits has taken time to implement and adjust.”
Just by seeking reimbursement, Ozoma and I appear to be in the vast minority. In Massachusetts during the first two weeks of the policy, WBUR reported that Blue Cross Blue Shield of Massachusetts got reimbursement claims from just 0.5% of its eligible members. Customers may not have known about the option or found it onerous, experts told the local radio station. Or they may not have felt like they needed it anymore. By the time the program went live, Omicron had appeared to peak there and cases were falling.
The timing was also off when the Biden administration finally reversed course and, in mid-January, started shipping half a billion free COVID tests to every household that requested a set of four online. By then, the holidays and holiday travel were over, and every day, cases in the US were averaging 750,000, hospitalizations were in the 20,000s, and about 1,750 people were dying. Right before Christmas, when he first announced the free tests, the president admitted, “I wish I had thought about ordering” them “two months ago.”
But that regret was avoidable, or at least foreseeable. Some scientists have been calling for more rapid tests since the pandemic started. In October, Vanity Fair reported, the federal government turned down a plan to distribute free tests for the holidays, reportedly because manufacturing capacity was not up to speed.
From day one, the Biden administration embraced vaccines, vaccines, vaccines as its core COVID strategy. “Early on, the US really invested in vaccination and made sure that after some initial rollout challenges, the vaccines were freely and widely available to those that wanted them,” Dawson said. “Other countries focused on vaccines, but also on testing. And that wasn’t something that happened domestically.”
Shots and boosters do prevent an astonishingly high percentage of the severe cases that end in hospitalization and death. But they do not completely prevent the spread of the coronavirus, as its increasingly infectious variants have shown. What became clear last year is that the US couldn’t rely on just vaccines, just masks, just social distancing, or just testing to keep COVID-19 at levels that our healthcare system could manage. We needed all of the above. Despite widely available tests, the UK experienced surges at the end of 2021, which experts said were likely due to lax masking and relatively low vaccination rates among teenagers.
Last summer, in the days before Delta and Omicron, the CDC told fully vaccinated Americans that they didn’t need to wear a mask indoors. Rapid test sales plummeted, and a major manufacturer of one of those tests destroyed inventory. Last month, the CDC told fully vaccinated Americans that they didn’t need to mask indoors in most places and nearly half of the 500 million rapid tests recently made available by the federal government remained unclaimed. (There are now so many you can order a second round.)
Are we about to repeat history? Tom Inglesby, testing adviser to the White House’s COVID-19 response team, told the Associated Press that this time, the administration understands the need to maintain testing infrastructure even when caseloads aren’t skyrocketing. “We totally intend to sustain this market,” he said.
If this volatile, unpredictable virus has taught us anything, it’s the importance of being preventive and proactive — not waiting until problems arise. Let’s hope we remember that lesson if and when the next variant rolls around.
By then, maybe I’ll have gotten my $86.82 back. ●