Burned by Low Reimbursements, Some Doctors Stop Testing for Covid
Some insurers pay pediatricians less than the cost of the test itself, jeopardizing a tool to help control the pandemic.
Dr. Robin Larabee was thrilled to start offering coronavirus testing at her pediatrics practice in Denver last fall. Testing for children is often scarce, and her new machines could return results within minutes.
She quickly discovered an unexpected obstacle: a major health insurer that paid her less than the cost of the test itself. Each kit Dr. Larabee purchased for her machines cost about $41, but the insurer sent back half that amount each time she submitted a claim.
Across the country, some doctors are seeing reimbursement rates so low that they do not cover the cost of the test supplies, jeopardizing access to a tool experts see as crucial to stopping the virus’s spread. “I’ve gone up the food chain, and gotten as far as I can, and they just tell me this is the rate,” she said.
She doesn’t use her new machines for that health plan’s enrollees anymore, instead sending their tests to an outside laboratory. That extra step means results take days rather than minutes to come back.
Burned by Low Reimbursements, Some Doctors Stop Testing for Covid
“All I did this summer was look at spreadsheets to figure out how much this would cost,” she said. “In 15 years of practice, this is the first time I’ve ever had to consider altering my care for a certain population.”
With new variants of coronavirus emerging, experts say testing will be especially important. But the low fees have led some doctors to stop testing certain patients, or to forgo testing altogether. The problem of low reimbursement rates appears to be most common with pediatricians using in-office rapid testing.
Image“In 15 years of practice, this is the first time I’ve ever had to consider altering my care for a certain population,” Dr. Larabee said.
“In 15 years of practice, this is the first time I’ve ever had to consider altering my care for a certain population,” Dr. Larabee said.Credit…Benjamin Rasmussen for The New York Times
“We are not doing Covid testing because we cannot afford to take the financial hit in the middle of the pandemic,” said Dr. Suzanne Berman, a pediatrician in Crossville, Tenn. Her clinic serves a low-income Appalachian community where coronavirus is now spreading rapidly, and 17 percent of tests are coming back positive as of this week.
