Independent pharmacies in New York argued with insurers over Covid-19 tests

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

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

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

US Department of Health and Human Services last year issued a guide allowing qualified pharmacy technicians to conduct tests for COVID and COVID vaccines, noting that pharmacies “are well positioned to help scale up COVID-19 testing.”

But insurers have different policies in which and when tests are covered. Crain’s It has previously reported

Ambar Keluskar, a pharmacist at Rossi’s Pharmacy in East New York, Brooklyn, said nearly all insurers have denied his claims for COVID sample collection fees, with the exception of some Medicaid managed care plans. Insurers say the service is not covered by insurance or that the pharmacy is in the wrong location, Keluskar said. Pharmacies like him rely on reimbursement of labor costs; Medicare’s sample collection rate is just over $ 23. (Labs process tests and bill them separately.)

“They have to pay for these services, but they just don’t want to do it,” he said.

The quick tests that pharmacies conduct and analyze are more of a game, he said, because they are more expensive and claims may not be considered for several weeks.

Leslie Moran, senior vice president of the New York Health Plan Association, which represents 28 insurers in the state, said insurers do not dispute that pharmacists can test for COVID. Moran attributed some of the problem to mis-billing and said the plans are working with pharmacies to fix errors in medical coding.

“It is unpleasant for both sides that this problem remains constant,” she said.

Moran also noted the difference between testing to diagnose COVID-19 and widespread testing for reasons such as travel or returning to school.

Rejected claims can always be challenged, Moran added. Pharmacists noted that this is easier said than done.

“It’s almost a constant job of finding insurers to get money,” Keluskar said.

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