UnitedHealthcare will reimburse pediatric and family medicine clinicians for COVID-19 tests administered in 2021, the insurer said in a letter to providers.
Healthcare professionals can provide proof of services and sign an amendment to their previous contract with UnitedHealthcare to receive 100% of CMS' rate for specific COVID-19 test codes, the email letter said. The offer applies to all past and future COVID-19 tests from Jan. 1, 2021 through Dec. 31, 2021.
The Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security Act required group health plans and health insurance issuers to cover COVID-19 testing services free of charge to patients, but providers are often left footing the bill with little reimbursement.
"The question is, who is paying the provider for the very real and time consuming service that they're providing," said Adam Block, an assistant professor at New York Medical College. "The insurers are not acting in a consistent way with how they reimburse providers for these services."
An analysis by Peterson-KFF Health System Tracker found that prices for COVID-19 diagnostic tests at a majority of large hospitals in the U.S. range from $50-$200, although some can cost as much as $1,400. Medicare reimburses providers between $36 and $143 on average for each diagnostic test, depending on the type of test and how quickly it is processed.
UnitedHealthcare was sued on Wednesday by Genesis Laboratory Management, which alleged the company failed to reimburse it for 51,000 claims for COVID-19 tests it provided to UnitedHealthcare beneficiaries. Genesis claimed that UnitedHealthcare, which reported $15.4 billion in revenue in 2020, violated New Jersey's Healthcare Information Networks and Technologies Act and the state's Health Claims Authorization, Processing and Payment Act.
The complaint also stated that while UnitedHealthcare paid the majority of the lab's claims for March, April and May 2020, it started "systematically denying" payment for claims in June 2020.
UnitedHealthcare did not provide comment by deadline.
According to the letter to clinicians, UnitedHealthcare's latest policy change offering reimbursements for family medicine health professionals and pediatricians is meant to address any provider concerns about affording COVID-19 tests.