Dr. Robin Larby was thrilled to begin offering coronavirus testing at his pediatric practice in Denver last fall. Test for children Often rare, And its new machines can return results within minutes.
She quickly discovered an unexpected obstacle: a major health insurer who paid her less than the cost of the test. Each kit is dr. Larabee bought for his machines, costing about $ 41, but the insurer sent half the amount back, the number of times he submitted the claim.
Across the country, some doctors are seeing reimbursement rates so low that they do not cover the cost of testing supplies, jeopardizing access to an equipment specialist is critical to preventing the spread of the virus. He said, “I have built the food chain, and as far as I could, and they told me it’s the rate.”
He does not use his new machines for the enrollment of that health plan, instead sending his tests to an outside laboratory. The additional step means that it takes days rather than minutes to return results.
“All I did was look at the spreadsheet over the summer to find out how much it would cost,” she said. “In 15 years of practice, this is the first time I’ve had to consider changing my care for a certain population.”
With the emergence of new variants of coronovirus, experts say Testing will be particularly important. But the low fees have prevented some doctors from discontinuing testing, or completely testing some patients. The problem of low reimbursement rates appears to be most common with pediatricians using in-office rapid testing.
“We are not conducting a Kovid test because we cannot afford to take a financial hit in the midst of an epidemic,” Dr. Said Susan Burman, a pediatrician in Crossville, Tenn. His clinic now serves the low-income Appalachian community where Coronavirus is located. Is spreading rapidly, and 17 percent The tests are coming up positive this week.
Rapid-office tests are less sensitive Compared to those who were sent to the lab, meaning they missed some positive cases. Are researchers Learning sequence in progress Regarding the efficacy of these tests in children. Nevertheless, infectious disease experts say rapid change tests are important to control the epidemic, especially in areas where other types of testing are less available.
“We definitely need to cover these tests,” said Sam Dominguez, medical director of the Microbiology Lab at Children’s Hospital Colorado. “If they come out positive, you have an answer right away and can go ahead and make a proper separation.”
Across the country, many doctors identified UnitedThelcare and some state Medicaid plans, which routinely pay trial rates that do not cover the cost of supplies.
Medicaid and Medicare often pay a lower price than private insurers. But the reimbursement of a large private insurer such as UnitedHealthcare came as a shock to doctors.
A spokeswoman, Matthew Wiggins, said that UnitedHealthcare was not low for coronovirus testing, and that its rates were in line with other health plans.
He said in a statement, “We want to make sure that every member has access to test and contact any provider for payment related questions to contact us so that we can address their concerns. “
Doctors have complained to UnitedThelcare and other health plans, however, saying they have been offered little intercourse. One was told that this was not an issue raised by another doctor. Another was directed to find a supplier with a lower price.
Many private insurers have prospered during the epidemic, with Americans greatly delaying medical care in 2020. By September, insurers’ monthly profit margins on large group health plans had increased. 24 percent.
This month, Minnesota-based UnitedHealthcare posted $ 15.4 billion in profits last year, up from $ 13.8 billion in 2019. 2020 financial review, It was anticipated that the costs of the coronavirus test would have an “adverse” effect on this year’s share price.
In mid-January, the American Academy of Pediatrics informed UnitedHealthcare about what problems its members were facing. It is still awaiting response. The California Medical Association has also raised this issue.
As with other health services, doctors usually have a way to recoup losses when they believe that insurer payments are not high enough: they can bill the patient directly for the remaining balance.
But when it comes to coronovirus testing, federal law prohibits it. Tried to make laws passed last spring Coronavirus test free For patients by prohibiting providers from billing patients for testing. It requires insurers to fully cover the costs of testing, but does not define what constitutes “full” reimbursement.
Pediatricians provide a much larger test structure for American children. Many large testing sites operated by health departments and pharmacies do not test children, although the demand for pediatric testing is expected to increase as more students return in-school.
Dr. Bob Stephens runs a solo pediatric practice in Segwyn, Texas. About 60 percent of his patients are Hispanic, and 50 percent of his patients are covered by the state Medicaid program.
He began offering rapid coronavirus testing in October, purchasing each kit for $ 37, but paid only $ 15 to $ 19 to plans covering his Medicaid patients.
He did a bit of digging: Texas managed its Medicaid program to private insurers, known as managed care organizations. For nearly all of last year, the state did not set reimbursement rates for in-office testing. Instead, it lets private insurers decide what they want to pay.
In late December, Drs. Stephens decided to stop offering rapid testing for Medicaid patients and provide it only with private insurers, whose plans typically paid $ 45 to $ 50.
“It’s morally difficult for me, because I like to treat everyone the same,” he said. “When there is a problem in my medical decision not to offer things to people, they are entitled to it.”
Aetna runs one of the Medicaid plans that Dr. Serves Stephens patients. A spokeswoman confirmed that it paid doctors $ 15 for a coronovirus test last year, but said its fee rose to $ 37.79 after receiving updated guidance from the state in recent weeks.
Elsewhere providers are using available tests, regardless of a patient’s insurance, taking some losses.
Atlanta area pediatrician Drs. Reshma Chugani said, “I feel torn between my obligation and my desire to see patients and my desire to stay in business.” She has found that most insurers fully cover the test, but UnitedHealthcare – the insurer for about a quarter of its patients – typically reimburses 60 percent.
His practice declined by 20 percent last year and the patient volume is still low. Some parents have closed welfare checks, and fewer children in school means less sick. He has instigated some staff members and asked others to work because of low revenue.
“It seems like a losing situation,” she said. “I can’t ask for a test, and drive my patients away. Or I can say yes, and working on the loss. “