WNY insurers will not cover Covid-19 tests for returns to work, school

Aug. 24--As some Western New Yorkers return to classrooms and offices this fall, many plan to get tested for Covid-19 to safeguard classmates and colleagues.

Some schools and employers even require such tests. Students at SUNY Geneseo can't return until they test negative for the disease.

But as of Sept. 1, none of Western New York's three major health insurance companies will cover such tests -- a policy shift that surprised even the region's leading public health officials. Dr. Gale Burstein, Erie County's health commissioner, called the shift "frustrating" and said it would "limit access to Covid-19 testing," particularly for low-income people.

"Anything that's a barrier to testing is a barrier" to pandemic control, said Dr. Peter Winkelstein, the executive director of the University at Buffalo Institute for Healthcare Informatics. "We need more testing and better turnaround times, not less."

The policy shift follows a June 23 memo from the federal Departments of Labor, Treasury and Health and Human Services, which clarified Covid-19 insurance mandates, said Dr. Stephen Cohen, the corporate medical director at Univera Healthcare.

Legislation passed by Congress in March initially required insurance plans to cover Covid-19 tests in full. But the June memo narrowed that requirement, ruling that insurers could deny coverage of testing for "public health surveillance" or "general workplace health and safety" purposes.

Now, according to policy documents released in recent weeks by Univera and Independent Health, members are only eligible for coverage of Covid-19 testing if a medical professional specifically requires it to make a diagnosis. In many cases, that will rule out tests for asymptomatic patients, though the Centers for Disease Control and Prevention estimates that 40% of all infected people never experience Covid-19 symptoms.

Testing performed "solely for purposes of pandemic control or re-opening the economy" will not be covered, according to Univera's new policy. Nor, per Independent Health, is screening for "for employment, school [or] recreation." BlueCross BlueShield added language to its website in May specifying it would not cover testing for "broad public health" or "surveillance" purposes.

These tests are not medically necessary, said Dr. Thomas Schenk, the chief medical officer at BlueCross BlueShield, and thus should be funded by schools, employers or government instead of insurance companies. At Erie County Medical Center, which publicly posts its procedural fees, a single Covid-19 test runs more than $100.

"We are not covering testing that is purely linked to return to work, the same way we don't cover drug screenings or things linked to employment policies," Schenk said. " ... It's [a question of] what is the purpose of health insurance, versus what is the purpose of the systematic ways that a business ensures safety for its employees?"

Free return-to-work testing is still available in Erie County at eight sites run by the state and county departments of health. In a statement, a state DOH spokesman reiterated that "there is never any charge for a test" conducted at a state-run testing location, such as the site in the Cobblestone District.

But Dr. Myron Glick, the founder and CEO of Jericho Road Community Health Center, said that's insufficient. The insurance policy change will "jeopardize" his clinic's testing program, he added, which has tested more than 9,000 people and relied on insurance to cover fees charged by private labs.

Glick argues that free, widespread surveillance testing is critical to identifying and isolating asymptomatic people before they spread the virus, particularly in the low-income and immigrant communities where Jericho Road works. The center's patients often live in multigenerational households and work in front-line environments.

Jericho Road will be lobbying local insurers to reconsider the policy, he said.

"Unfortunately, the executives who make these decisions can afford to pay out-of-pocket for their children to have tests," Glick said. "A lot of our patients can't."

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