ACA Fully Covers Lab Fees for Covid-19 Tests: Know Your Rights

The Affordable Care Act (ACA) mandates health insurance plans to fully cover the costs of COVID-19 testing, including lab fees. However, as illustrated by a recent case, it’s possible that insurers might deny coverage or attempt to shift the responsibility onto policyholders. In this blog post, we’ll delve into the details of ACA coverage for Covid-19 testing, empowering you with the knowledge to protect your rights and ensure you receive the full benefits you’re entitled to.

ACA Requirements for Covid-19 Testing Coverage

According to the CARES Act and FFCRA Act, health insurance plans are obligated to cover the following aspects of Covid-19 testing:

Diagnostic testing: This includes the actual test itself, including collection and analysis costs.
Out-of-network labs: Even if the lab where your test is processed is not part of your plan’s network, the insurer must cover the cost up to the amount that would be charged by an in-network lab.
No cost-sharing: Insurers cannot impose any deductibles, copays, or coinsurance for Covid-19 testing.
Emergency period: The mandate applies retroactively from March 18, 2020, and is still in effect.

What to Do if Your Insurer Denies Coverage

If your insurer denies coverage for Covid-19 lab fees, you have the right to appeal the decision. Here are the steps to follow:

Contact customer service: Call or write to your insurer’s customer service department to request a formal appeal.
Document your request: Keep a record of your phone calls, emails, and any other correspondence related to your appeal.
Provide evidence: Include documentation that supports your claim, such as lab bills, insurance EOBs, and copies of any relevant laws or regulations.
Be persistent: Don’t give up if your initial appeal is denied. You can request an internal review or file a complaint with the appropriate state insurance regulator.

Additional Tips for Ensuring Coverage

Check your eligibility: Confirm that your health insurance plan is subject to ACA requirements. The majority of employer-sponsored plans and individual health insurance policies fall under ACA regulations.
Ask about covered labs: When taking a Covid-19 test, inquire which labs are covered by your insurance plan. If possible, choose a lab within the network to avoid potential issues.
Keep receipts: Save any receipts or bills related to Covid-19 testing, even if your insurer has already paid. This documentation will be helpful if you need to appeal or file a complaint later on.

Know Your Rights and Protect Yourself

The ACA guarantees comprehensive coverage for Covid-19 testing, ensuring that all Americans have access to the necessary healthcare without financial burden. By understanding your rights and taking these proactive steps, you can safeguard your health and financial well-being during this challenging time.