Private health insurers must assess public health data


Is it in the interest of health insurance providers to continue to offer free COVID-19 test kits once they are no longer mandatory? Health insurance expert Melanie Musson explores the need for data, evaluation and making the best decision based on facts.

COVID-19 public health emergency

In April 2022, the COVID-19 Public Health Emergency (PHE) was extended for 90 days, which expires around mid-July.

Georgetown University’s Health Policy Institute shared that the Biden administration previously indicated it would give 60 days notice before the PHE expires. So, since there was no notification, the administration is expected to extend the PHE.

In January 2022, the Department of Health and Human Services announced that the Biden-Harris administration was requiring health insurance providers to cover the cost of at-home COVID-19 test kits.

Even though it looks like health insurance providers will continue to be required to cover some COVID-19 services like free test kits in the short term, in the long term the public health emergency will end. Thus, insurers must weigh the benefits of continuing previously mandatory coverages.

The value of data

Health insurance providers need to start collecting data now, so they have time to collect information and evaluate results. They must consider several factors when developing a post-emergency action plan.

First, they must consider the results of frequent tests. For example, if individuals test frequently, will they be more likely to self-quarantine after a positive test result than if they just felt sick?

Second, providers should seek to demonstrate whether there is evidence that frequent testing leads to lower rates of community spread and hospitalizations? Since hospitalizations are so expensive, insurers could save a lot of money by avoiding paying hospital claims. It would take a lot of 100% covered test kits to equal the cost of hospitalization.

Third, insurers should seek to discover whether the insured’s response to suspected COVID-19 changes whether test kits are covered like other medical tests or are 100% covered. For example, it is possible that if someone suspects they have COVID-19, they would be willing to pay a copayment for a test kit, but would be less likely to get tested if they do not present. of symptoms.

In addition, providers need to consider whether initial coverage is more effective than Reimbursement for COVID-19 tests is more efficient than

Policyholder response should influence decisions

Some policyholders can take advantage of the free tests and get tests for fun. Sometimes when they test, they may have a positive result that they wouldn’t have detected so soon, which can help them avoid interacting with others and spreading COVID-19. But providers must evaluate the data to determine if it is conjecture or if it is fact.

The key should be to find out whether free testing decreases community spread and whether it is superior to partially covered testing in terms of outcome.

COVID-19 is here to stay, and if insurers figure out how best to handle testing, they can form the best policies, help save lives, and offer policyholders the lowest possible premiums while maintaining solvency.


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