- The California Medical Association is accusing UnitedHealthcare of failing to adequately reimburse physicians for COVID-19 rapid antigen testing and has reiterated its call for regulators to investigate and take action to prevent insurers from hampering patient access to appropriate coronavirus testing.
- The doctors group, whose members include nearly 50,000 physicians, residents and medical students, said in statement it is concerned that UnitedHealthcare is not increasing reimbursement for the rapid antigen test, even after the insurer notified physician practices that it would cover some COVID-19 test codes at 100% of CMS rates.
- CMA's statement comes a week after HHS Secretary Xavier Becerra warned health insurers and providers in a letter that COVID-19 testing and vaccines must be free of charge for patients. UnitedHealthcare did not return a request for comment by the time of publication.
Catching COVID-19 cases early and preventing their spread remains a top priority of the Biden administration. Becerra's letter reminding insurers of their legal obligation to cover coronavirus diagnostic testing services follows reports of cost concerns deterring consumers from seeking COVID-19 vaccinations and tests.
HHS, the Labor Department and the Treasury Department in February issued guidance spelling out a requirement that health plans and insurers cover COVID-19 diagnostic testing without cost-sharing. The goal is to remove cost worries as a barrier for Americans as they decide whether to get tested.
Becerra's letter further states that group health plans and insurers are prohibited from delaying COVID-19 testing or making it more cumbersome and costly, through prior authorization or other requirements.
The CMA said it received a number of calls from physician practices about insurers inadequately reimbursing for COVID-19 testing before it asked state regulators in February to investigate reports that some health plans were shifting financial risk to doctors by reimbursing at rates far below the cost of the test.
CMA asked the California Department of Managed Care and the California Department of Insurance in February to investigate the concerns because the practice appeared to be inconsistent with both agencies' requirements for COVID-19 diagnostic testing and the federal Coronavirus Aid, Relief and Economic Securities Act.
The physicians group said it subsequently learned that UnitedHealthcare sent a notice to some pediatric and family medicine practices indicating it would increase reimbursement for COVID-19 testing. The testing rate amendment said UnitedHealthcare would reimburse 10 COVID-19 test codes at 100% of the CMS rate for individual exchange, individual, and fully insured group market health plans, CMA said.
UnitedHealthcare confirmed sending notices to physician practices, according to the association.
CMA said it remained concerned that UnitedHealthcare is not raising reimbursement for rapid antigen tests, which are used at the point of care and provide a result in about 15 minutes, after hearing from physicians that the insurer, along with Anthem, was reimbursing at less than half of the physicians' costs.
A rapid antigen test kit costs doctors about $35 to $40.
CMA said it has "strongly urged regulators to formally investigate and take appropriate action to ensure payors are not impeding patients’ access to appropriate and necessary COVID-19 testing and profiting at the expense of treating physicians."