C-19 Testing for Hawaii and Insurance

[Henry M.]

I paid for my COVID test last November, because the testing company (Vault) didn't want to deal with insurance. I think CVS and others are like that too. They provided a receipt to send in but I just assumed it wasn't covered. When I was talking to my insurance company a couple of months later, I mentioned COVID testing to the representative and they said it was covered in full. I could also get as many as I needed. I sent in the receipt I still had, and I got 100% reimbursement!

Check with your insurance company even if you pay out of pocket to get the test.

 

[NTP66]

Pretty sure that the Walgreen's tests are all 100% paid by your insurance, so no out of pocket costs.

 

[csodjd]

I paid for my COVID test last November, because the testing company (Vault) didn't want to deal with insurance. I think CVS and others are like that too. They provided a receipt to send in but I just assumed it wasn't covered. When I was talking to my insurance company a couple of months later, I mentioned COVID testing to the representative and they said it was covered in full. I could also get as many as I needed. I sent in the receipt I still had, and I got 100% reimbursement!

Check with your insurance company even if you pay out of pocket to get the test.

I just have a hard time asking my insurance company to reimburse or cover for a test I need so I can travel to Hawaii. That’s really not what insurance is for and it feels like taking unfair advantage.

 

[rickandcindy23]

Kaiser covers ours and had the results in 12 hours. Our kids paid and do have insurance.

 

[CalGalTraveler]

Good news but we are traveling in 8 days. Will likely need to take the test because 72 hours prior.

We are not using Kaiser because they take 48 hours plus where we live in norcal. Will take from one of the providers that is partnering with Southwest to ensure all the paperwork is completed on time.

 

[CalGalTraveler]

I just have a hard time asking my insurance company to reimburse or cover for a test I need so I can travel to Hawaii. That’s really not what insurance is for and it feels like taking unfair advantage.

If you were traveling to Africa and needed travel vaccinations they would cover you.

IMHO...we pay close to $25k a year on Kaiser and we now have copays of $40 for xrays and $150 for a CT. I wouldn't feel sorry at all. Is it also possible that these insurance firms are being reimbursed by the government and that's why there are so many free tests out there?

 

[csodjd]

If you were traveling to Africa and needed travel vaccinations they would cover you.

IMHO...we pay close to $25k a year on Kaiser and we now have copays of $40 for xrays and $150 for a CT. I wouldn't feel sorry at all. Is it also possible that these insurance firms are being reimbursed by the government and that's why there are so many free tests out there?

Vaccinations have broader implications — they protect you from getting diseases, no matter where you may be. That benefits you and the insurance company. It may be the trip that motivated the vaccine, but the vaccine protects you no matter where you go. These tests are largely one-off, and not needed for any symptom or apparent risk. They don’t protect you or your insurer from anything. They just allow you to avoid quarantine. So while I get your point, and perhaps it’s just me, that’s my personal view.

 

[Henry M.]

Why would you give up on a service that is explicitly included in the membership fees of any organization or club you join? Would you not accept a benefit useful to you from your timeshare organization, or from Costco, or from any other group that you pay membership fees to? I'm interested in the viewpoint, not in trying to change your mind.

In my case, it was the insurance company that encouraged me to send in the claim. I had mistakenly assumed it wasn't covered.

 

[csodjd]

Why would you give up on a service that is explicitly included in the membership fees of any organization or club you join? Would you not accept a benefit useful to you from your timeshare organization, or from Costco, or from any other group that you pay membership fees to? I'm interested in the viewpoint, not in trying to change your mind.

In my case, it was the insurance company that encouraged me to send in the claim. I had mistakenly assumed it wasn't covered.

I understand my insurance to be insuring me against the risk of unwanted illness or injury. Just as it doesn't pay for my medical care for elective cosmetic procedures, I would not expect it to be insuring me against the "risk" I will want to go to Hawaii on vacation.

 

[slip]

I understand my insurance to be insuring me against the risk of unwanted illness or injury. Just as it doesn't pay for my medical care for elective cosmetic procedures, I would not expect it to be insuring me against the "risk" I will want to go to Hawaii on vacation.

I felt the same way about this. I only had to have a couple tests for travel and I paid for it myself and work paid for one too.

 

[NTP66]

I won’t feel sorry at all for IBX covering the tests. Working in healthcare for as long as I have, most probably wouldn’t.

 

[Henry M.]

I wouldn't expect them to cover me, but since they do, why not accept the coverage? I'm not talking about forcing them to have coverage, just accepting an offer they made.

To play even more devil's advocate, the test is not so much for me, but to keep those around me safe. They all get a benefit, not me. A positive test means its too late for me. A negative one tells them they can feel safe to be around me and to let me come spend my money. In fact, if the state wants to demand I get tested, perhaps the state should provide and pay for the test.

 

[1Kflyerguy]

We did the tests for our Big Island trip last month with City Health. They had a list of Insurance companies that cover travel related tests on their site when we booked our test appointments. We have Aetna, and they covered the test, though i did have to pay City Health for processing the Hawaii specific paperwork.

Prior to receiving my vax, i had been testing with the county every few weeks just to monitor. The country tests were always free to me, though they asked for insurance information and Aetna reimbursed the country for all my tests.

 

[csodjd]

I wouldn't expect them to cover me, but since they do, why not accept the coverage? I'm not talking about forcing them to have coverage, just accepting an offer they made.

To play even more devil's advocate, the test is not so much for me, but to keep those around me safe. They all get a benefit, not me. A positive test means its too late for me. A negative one tells them they can feel safe to be around me and to let me come spend my money. In fact, if the state wants to demand I get tested, perhaps the state should provide and pay for the test.

I guess since I'm sort of in the business, defending doctors being audited by payers, I wonder what the ICD-10 code is that is being used for the test? I suspect it's not a code for "Vacation Travel." I suspect instead that providers (across the US) are being paid because they're using an ICD code conveying COVID risk or symptoms. The question isn't whether the plans paid it -- I can get LOTS of things paid for by manipulating codes -- the question is whether it is a covered benefit when it is fully/correctly disclosed.

 

[Henry M.]

I guess since I'm sort of in the business, defending doctors being audited by payers, I wonder what the ICD-10 code is that is being used for the test? I suspect it's not a code for "Vacation Travel." I suspect instead that providers (across the US) are being paid because they're using an ICD code conveying COVID risk or symptoms. The question isn't whether the plans paid it -- I can get LOTS of things paid for by manipulating codes -- the question is whether it is a covered benefit when it is fully/correctly disclosed.

The code on my receipt is ICD10 Z03.818 Possible exposure to COVID-19, which is why the test is needed. If there was no possible exposure, the test wouldn't be needed, I guess. Exposure to COVID-19 is possible any time you are near others.

In my case, it was the insurance company that suggested sending in the claim, with the agent knowing the test was taken to fulfill the Hawaii travel requirement.

 

[csodjd]

The code on my receipt is ICD10 Z03.818 Possible exposure to COVID-19, which is why the test is needed. If there was no possible exposure, the test wouldn't be needed, I guess. Exposure to COVID-19 is possible any time you are near others.

In my case, it was the insurance company that suggested sending in the claim, with the agent knowing the test was taken to fulfill the Hawaii travel requirement.

That's a false claim submission in my view. The ICD is driven by the "chief complaint" or "reason" for the test. If you told a provider/doctor that you were concerned because you were near someone that later tested positive, that's perfectly legit. But if you say, "I'm going to Hawaii" and they use "possible exposure" as the justification for the test, it's false.

The ICD is not driven by "is possible." It is driven by signs and symptoms. I can only imagine how it would turn out if as an eye doctor I ordered blood work on every patient because it is possible they have an elevated A1C, or if I performed a retinal angiogram because it's possible they have choroidal neovascularization. They would lock me up for insurance fraud.

 

[CalGalTraveler]

What is being described sounds more like a traditional catastrophic insurance plan. Perhaps that is the type of insurance you have which is typically claims based.

We belong to an "HMO." Wasn't the entire reasoning behind "Health Maintenance Organization" that preventative office visits such as regular check-ups and screenings such as mammograms, cholesterol blood work etc. (in which you are not sick) are covered? It is about wellness, not illness. To me it's like using a benefit of a credit card that may not be central to the cards purpose, such as free Global Entry.

IMHO...If you don't have an HMO or don't feel right about it, that is certainly your perogative. I view it as part of the package for an HMO like Kaiser that already owns and pays for fixed facilities and has fixed staff salaries so the incremental cost of running a test is miniscule.

Traditional insurance companies who don't already have such fixed costs approach any expense as something to be approved or denied because such costs are variable to them and affects their bottom line.

 

[csodjd]

What is being described sounds more like a traditional catastrophic insurance plan. Perhaps that is the type of insurance you have which is typically claims based.

We belong to an "HMO." Wasn't the entire reasoning behind "Health Maintenance Organization" that preventative office visits such as regular check-ups and screenings such as mammograms, cholesterol blood work etc. (in which you are not sick) are covered? It is about wellness, not illness. To me it's like using a benefit of a credit card that may not be central to the cards purpose, such as free Global Entry.

IMHO...If you don't have an HMO or don't feel right about it, that is certainly your perogative. I view it as part of the package for an HMO like Kaiser that already owns and pays for fixed facilities and has fixed staff salaries so the incremental cost of running a test is miniscule.

Traditional insurance companies who don't already have such fixed costs approach any expense as something to be approved or denied because such costs are variable to them and affects their bottom line.

Yes, there’s some truth there. You are describing HMO capitated or staff model care vs. PPO/fee-for-service care. In the former maximum profit is achieved by delivering the least amount of care, making preventative care valuable. In the former maximum profit is achieved by providing care.

However, at the heart of HMO care is the gatekeeper. The gatekeeper (normally that’s your assigned PCP but also the HMO UM department) has the job of ensuring no care is provided that’s not medically necessary and that the least expensive option is utilized among various choices. For instance, the PCP may decide he/she can treat this problem and a specialist isn’t needed. Or utilization management may decide PT is a better option than surgery, or a less expensive drug would be as good a choice as a more expensive one, or an MRI that your doctor ordered isn’t warranted. In the context of COVID tests, there IS a cost to the HMO in time, supplies, etc. Doing a test that has NO medical necessity is directly contrary to their economic model.

Whether in an HMO or PPO environment (each of which has its pros and cons), the heart and soul of care is “medical necessity.” Both are based on managing risk, and when you introduce not-medically necessary care it interferes with their cost underwriting.

 

[Dean]

If you were traveling to Africa and needed travel vaccinations they would cover you.

IMHO...we pay close to $25k a year on Kaiser and we now have copays of $40 for xrays and $150 for a CT. I wouldn't feel sorry at all. Is it also possible that these insurance firms are being reimbursed by the government and that's why there are so many free tests out there?

Many insurances specifically exclude travel vaccines and many won't cover tests they could have done at a contracted provided if done elsewhere other than under an emergency situation, usually with an ER copay associated. That said, if they do them in house they usually end up not charging. For the Oral vaccines you get through the pharmacy it depends on the formulary setup. I work for a not for profit HMO, a very good one that covers most things, and they do not cover travel vaccines that are injectable. This is spelled out in the contract. So yellow fever, rabies and the like wouldn't be covered. Normally for things we do in house they don't charge but they technically could like Hepatiis A or Meningococcal B. I'd certainly ask but understand that they may not be covered.

 

[CalGalTraveler]

I find that our docs at our HMO tends to run more tests and send to specialists than other systems. I have a relative who is a primary care doc who works for Kaiser. He told me that if there is any question, he refers to the specialist or tests for three reasons: 1) The primaries are given so little time to diagnose per appt that referring to a specialist is the most CYA for malpractice; 2) there is no penalty for referring; 3) The docs are rated by the patients. Referrals keep patient satisfaction high.

We had a relative who had a severe and complex disease and we wanted to try an experimental treatment which involved an IV for 3 days in the hospital. While traditional insurance would deny coverage for such a procedure because it is "experimental." The HMO specialist approved it because the docs make the ultimate medical decision, not an insurance company. While an insurance company would have to pay for 3 nights in a hospital, Kaiser has fixed facilities and hospital staff on salaries so the incremental cost was only the IV drug cost as long as a bed was available. So the risk was not great for the HMO but would be significant for an insurance company. We are grateful the doc was willing to approve this and give it a try.

Different business models drive different outcomes.

 

[csodjd]

I'll try my wife. She got her shots at a UCLA clinic in Calabasas.

My wife is in the CA system and shows as vaccinated. So UCLA we know was reporting. I went to “Medical One,” one of the new style concierge type primary care businesses. I had to sign up for a free 90-day trial with Medical One and that made me eligible to get vaccinated by them.

 

[TheHolleys87]

OTOH, re the code “possible exposure to COVID-19,” that’s why Hawaii wants the test, right? Because there’s a possibility we were exposed to COVID-19 through our activities, no matter how limited, prior to traveling to Hawaii and could have asymptomatic but transmissible infection. I was required to be tested prior to surgery in 2020, despite being asymptomatic, and my insurance paid for it along with the other preop evaluations I was required to have.

 

[Henry M.]

I never told the provider anything. I needed to get a COIVD test through the Hawaii Trusted Traveler Program. The state of Hawaii was concerned that I was exposed and wanted a test to make sure I wasn't. At this point in time, I'm not sure you can say concern about exposure before taking a trip is not valid and that testing is not in the best interest of the public, both during travel and once I get to Hawaii. Things are getting better, but concern about exposure is valid, whether I'm traveling to Hawaii or just getting together with others, at work, at home, or elsewhere.

 

[csodjd]

I never told the provider anything. I needed to get a COIVD test through the Hawaii Trusted Traveler Program. The state of Hawaii was concerned that I was exposed and wanted a test to make sure I wasn't. At this point in time, I'm not sure you can say concern about exposure before taking a trip is not valid and that testing is not in the best interest of the public, both during travel and once I get to Hawaii. Things are getting better, but concern about exposure is valid, whether I'm traveling to Hawaii or just getting together with others, at work, at home, or elsewhere.

To be clear, coding and billing is not your/the patient’s responsibility, it is the provider. That said, there is no insurance coverage for the concerns of the State of Hawaii. Hawaii doesn’t want you coming over with COVID. They also don’t want you coming over and having a heart attack or stroke, or with TB or an STD. They don’t want you driving with poor vision or a seizure disorder. None of that plays a role in whether your medical insurance covers testing for any of those things. (And, on an aside, Hawaii does NOT require a COVID test to come to Hawaii, they require it to not have to quarantine when you arrive, so the premise above is inaccurate… the COVID test is just for your convenience and pleasure, not to allow the travel.)

I don’t fault anyone for taking advantage of a provider offering a “free” test. I was asked why I don’t believe it is right and I answered… I think underlying that free test is probably false claims or even outright insurance fraud — to the detriment of those providers that are playing by the rules and charging for these Hawaii trip tests because they are not medically necessary. I’m not sure that is good or healthy for any already problematic health care/insurance industry.

 

[Henry M.]

I still see a concern about COVID exposure before taking a trip as a valid reason to test. Testing for something of concern, like any of the other things you mentioned, seems like a valid reason to test, no? The patient is looking out for fellow travelers as well as making sure they won't be sick when they go on a trip.

I'm not trying to find loopholes, but rather look at the issue from different perspectives.