Under federal rules, Highmark and other private health insurers are required to cover up to eight over-the counter, at-home covid-19 tests per person, per month beginning Saturday.
Highmark, which provides health insurance coverage to more than 6 million people in Pennsylvania, is looking to limit how much it will pay for tests bought outside that network.
Highmark customers will be able to submit claims online, said Bob Wanovich, vice president of provider contracting. A receipt will be required; purchases made before Saturday will not be covered.
Those without online access should call Highmark for help in submitting a claim, he said.
"The biggest issue for most people is finding access to tests," Wanovich said.
In separate statements, UPMC Health Plan and Aetna said they are reviewing the federal requirements and assessing the implications.
Wanovich said most tests come with two per box. In that case, the one box would count as two tests for reimbursement.
He said about a dozen test brands and versions have received emergency use authorization and will be covered.
They do not require prescriptions or sending samples to labs. The testing is done entirely at home, with results in 10 to 15 minutes.
Legitimate businesses sell only authorized tests, Wanovich said. He warned about the existence of fraudulent tests and cautioned against buying tests from unfamiliar websites.
"People need to be smart about where they are getting their tests," he said.
Wanovich said Highmark will fully reimburse the cost of tests regardless of variations in price or where they are bought.
"Our responsibility is to cover these," he said.
Wanovich could not say how long it will take for Highmark members to get their money back.
"We'll handle them as quickly as possible," he said. "We are making sure we have plenty of people. We're adjusting our staffing and so forth to handle the expected increased volume of these kind of claims coming in."
That will change when Highmark gets its preferred network running. Once that is in place, Highmark members will not have to pay up front and then seek reimbursement for tests bought within the network. Highmark will cap the reimbursement amount at $12 per test for those bought outside the network.
The $12 cap was set by the government, Wanovich said. It does not go into effect until the network is established. Wanovich said he did not know when that will happen.
Highmark will notify its members after the network is created, explain its value and encourage its use, Wanovich said.
In a statement, UPMC Health Plan said it is assessing implementation requirements.
"There are significant complexities associated with this new mandate that require unique solutions, and we are committed to comprehensively and efficiently administering this benefit in full compliance with the new federal regulations," the insurer said.
"Members who purchase tests on or after Jan. 15 should save their payment receipts and test packaging with bar codes. UPMC Health Plan will have additional details about how to submit requests for reimbursement very soon."
Aetna said it plans to adjust its coverage polices as appropriate.
Brian C. Rittmeyer is a Tribune-Review staff writer. You can contact Brian at 724-226-4701, [email protected] or via Twitter .
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