At-Home COVID Test Reimbursement
Today’s video addresses at-home COVID test reimbursement and details my frustrating journey which is not yet complete. I will begin with my recommendations to those seeking reimbursement from their health plan:
- Determine your plan’s process for requesting reimbursement (CIGNA continues to surprise me)
- Submit one claim to test process and then consider bundling them for the remainder of the benefit year
Background
In January of this year, a Biden administration ruling led to most Americans having coverage for eight at-home COVID tests per month per person. It can be problematic for insurance companies to deal with these types of requirements thrust upon them but I thought that later in the year, the process would be more straightforward than what I have encountered.
My Journey
My husband and I contracted COVID in July and although the dollars were small, one receipt for $23.99 and another for $71.97, I decided to submit a request for reimbursement. I found a claim form CIGNA had developed for this sole purpose online (attached at the bottom of this copy) and submitted the claims which were both denied. I used the chat feature on my portal to inquire about the denial and was initially told this was not a covered benefit. I have copied and pasted our exchange below (the rep, Zed, thinks my husband is the one on the chat, hence the reference to “John”).
CIGNA Chat 8-5-2022
John- 4:44 pm: Thank you very much, John. As per checking here, this is not a covered item and your plan does not provide coverage for these expenses.
John- 4:45 pm: I think that is not correct or you wouldn’t have developed a specific claim form for those expenses.
John- 4:47 pm: The government mandated coverage of up to eight tests per month. I’ll take this up with my employer.
Zed- 4:53 pm: May I know how did you submit this claim, John? And also let me provide you the coverage, one moment.
John- 4:53 pm: it was faxed to the fax number on the CIGNA claim form.
Zed- 4:55 pm: One moment please, let me verify the information here in my end.
Zed- 54:00 pm: Thank you very much as per double checking here in my end, your covid OTC test is covered under your pharmacy benefits, John. They are the one will gonna assist you with the processing of your claim, and here is the phone number (800) 601-6364.
Zed- 5:01 pm: The reason it has been denied here in your medical plan because it is covered in your pharmacy plan.
John: The form said to mail the form to the back of the address on the ID card or fax to a specific number. We’ve both spent way too much time on this but thanks.
John :I have resubmitted these two requests for reimbursement to Caremark, our pharmacy benefits manager, but we have yet to be reimbursed. Even more confusing is that there is now a place on the CIGNA portal to submit reimbursement claims with no reference to the previous direction that coverage is provided through the pharmacy benefit rather than the medical benefit. Exasperating!
What to make of this?
One can’t be sure. Given the bureaucratic and wasteful claims process that is part of our healthcare system, we all must decide how much time to devote to getting small dollars back. But my journey has been extremely problematic.
If you are considering submitting a claim for reimbursement, we encourage you to try to determine how your insurer is administering this benefit and test the process with a single claim submission.
Another avenue is to avoid the claims reimbursement process altogether if possible. Some plans have the option of ordering COVID tests through their mail order pharmacy at no charge. For this scenario, you would obviously want to order in advance of your need for a test. Your plan may also have special arrangements with certain pharmacies to pick tests up at no charge using your insurance card. The Federal mandate for coverage of at-home COVID tests will likely sunset soon, but for now it is still in place.
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