Want free, at-home COVID-19 tests from pharmacies and insurers? It’s not always easy, despite requirements – Chicago Tribune

Some Illinois residents say they’re nonetheless having hassle getting free at-home COVID-19 exams from pharmacies and insurance coverage firms, greater than three months after the White Home started requiring insurers to cowl them.

President Joe Biden’s administration introduced in January, amid an intense COVID-19 surge, that medical health insurance firms could be required to cowl as much as eight at-home COVID-19 exams a month per individual. Individuals have been supposed to have the ability to stroll into many pharmacies, flash their medical health insurance playing cards and stroll out with free packing containers of at-home COVID-19 exams. Or, if a pharmacy wasn’t in-network with their insurance coverage, an individual was supposed to have the ability to submit a declare for reimbursement for no less than $12 a take a look at.

But it surely’s nonetheless not all the time that straightforward — an issue that comes as Illinois case numbers are once more rising, prompting many individuals to once more search at-home exams.

Some pharmacies are demanding prospects pay for the exams upfront after which submit claims to their insurers for reimbursement regardless that the pharmacies are amongst these which might be supposed to simply accept insurance coverage for the exams. Different pharmacies are permitting prospects with insurance coverage to get the exams for gratis, however asking that they wait so long as two hours for them. Some pharmacies say they’re out of inventory, whereas others have cabinets brimming with the exams.

Those that purchase the exams at pharmacies exterior of their insurance coverage firms’ networks are typically discovering they need to fill out complicated kinds to submit claims for reimbursement.

“It’s extremely challenging and I don’t think it needs to be,” mentioned Teena McClelland, 46, of Portage Park.

McClelland likes to have COVID-19 exams on-hand so she will be able to take a look at her household earlier than gathering with others. She additionally desires to ensure she has them in her residence in case there’s one other COVID-19 surge, and the exams once more turn out to be scarce.

In early April, she tried to purchase at-home exams from a CVS Well being pharmacy however was advised they have been out of inventory.

“I was kind of surprised by that because I just kind of assumed pharmacies had this on-hand at this point in the game,” McClelland mentioned.

A few weeks later, she then ordered them on-line from a CVS via Instacart, paying for them upfront. She now has to submit a declare for reimbursement. She additionally determined to attempt to get some immediately via her insurance coverage firm, Blue Cross and Blue Protect of Illinois. She known as Blue Cross and spent an hour on the cellphone being transferred to totally different representatives earlier than one was in a position to order the exams for her, she mentioned. A bag of exams arrived lower than per week later.

Blue Cross spokesman John Simley mentioned, in an e-mail, that her expertise “isn’t typical,” and members can order free exams on-line or name Specific Scripts Pharmacy, a mail-order pharmacy that contracts with Blue Cross, at 833-715-0942.

“Every time I have been attempting to do something like this recently, I can’t help but think about people who are having more challenges,” McClelland mentioned. “I feel like I have limited challenges. For me to feel challenged by this process, I know it’s got to be so much worse for other people to the point that no one pursues it.”

McClelland isn’t the one one leaping via hoops to get the free exams, which might in any other case value greater than $20 for a set of two. That value may be problematic for many individuals, contemplating that some specialists advise individuals who aren’t feeling properly to take the exams as typically as every day, in some circumstances, to see if they’ve COVID-19.

A Tribune reporter lately visited greater than half a dozen pharmacies to attempt to get free at-home COVID-19 exams, coated by insurance coverage. The Tribune solely visited pharmacies listed as being a part of Prime Therapeutic’s community with Blue Cross and Blue Protect of Illinois, the state’s largest well being insurer, that means these pharmacies have been supposed to permit prospects with Blue Cross/Prime to get the exams free of charge. Prime is a pharmacy profit administration firm owned by Blue Cross firms.

Pharmacy staff at two Mariano’s shops advised the Tribune they weren’t operating the at-home exams via insurance coverage, and prospects needed to pay for them upfront and submit claims for reimbursement.

Three Walgreens pharmacies mentioned they may run the exams via insurance coverage, however it could take anyplace from quarter-hour to 2 hours. A pharmacy employee at a Jewel-Osco pharmacy mentioned he might run the exams via insurance coverage in 20 minutes, however the retailer solely had one field left and wouldn’t get extra in inventory for per week.

A pharmacy employee at a CVS retailer mentioned the exams might be run via insurance coverage in 20 to half-hour, however the exams have been in a distinct a part of the shop. They have been close to the money registers on the entrance of the shop, that means an individual must discover them on the entrance of the shop after which take them to the pharmacy within the again to get them coated by insurance coverage. Individuals may purchase them at registers within the entrance, however must pay for them out of pocket when doing so.

When requested why the 2 Mariano’s shops wouldn’t take insurance coverage for the exams, regardless of being listed as in-network with Blue Cross/Prime, a Mariano’s spokeswoman mentioned in an announcement, “Mariano’s continues working to align all insurance plans with our system allowing us to submit for reimbursement directly.”

Marci Conlin, vice chairman of pharmacy community administration for Prime Therapeutics, mentioned in an announcement that: “Any pharmacy in Prime’s network is able to run an electronic claim for over-the-counter (OTC) COVID-19 test kits. … Prime continues to educate pharmacies on the process to submit claims.”

Simley, with Blue Cross and Blue Protect of Illinois, mentioned lots of the issues Blue Cross has encountered contain “pharmacy procedures or correcting member information.”

“We’re continuing to educate participating pharmacies to make sure they’re following the process outlined by the federal government,” Simley mentioned. “If you use a pharmacy in Prime’s network, you should not have to submit a separate claim for reimbursement when you purchase the tests at the pharmacy counter.”

Relating to the lengthy wait occasions at some Walgreens pharmacies, Walgreens spokeswoman Kris Lathan mentioned in an e-mail, “Wait times vary based on peak times of the day for that location (like the hour before the store closes, for example).”

Jewel-Osco spokeswoman Mary Frances Trucco mentioned in an e-mail, “All of our Osco Drug Pharmacies are fully stocked with COVID-19 at home tests,” when requested if Jewel shops are low on exams.

A spokesman for CVS Well being mentioned in an e-mail that prospects with sure forms of insurance coverage can go to or use the CVS pharmacy app to find, order and decide up at-home COVID-19 exams at no upfront value, or can get coated exams from pharmacy counters. He mentioned CVS shares the exams in numerous areas at its shops, together with on the pharmacy counter.

Some Illinois customers are bypassing pharmacy counters altogether to attempt to get free exams, with various levels of success.

The federal authorities is permitting folks to rise up to eight free exams per family via Individuals can get free exams on that web site no matter insurance coverage standing.

Some individuals who need greater than these eight exams from the federal authorities are ordering them via shops’ web sites or via their insurers on-line.

Lisa Kelly, 39, of Jefferson Park, purchased exams from Walgreens and Walmart’s web sites, paying upfront after which submitting claims for reimbursement. She needed to fill out kinds from OptumRx, the prescription drug profit supplier for her insurance coverage plan with Aetna. “It’s really kind of confusing,” she mentioned.

She’s additionally ordered the exams immediately via an Optum web site, with no upfront value, however she hasn’t but discovered methods to order eight a month for every of her relations, somewhat than simply for herself and her husband.

“Perhaps if I had done the paperwork reimbursement route that would have worked, but that’s a lot of money upfront,” she mentioned.

Members of Blue Cross and UnitedHealthcare may order as much as eight exams month-to-month for every individual of their family for gratis, via insurance-related web sites. However an individual with Blue Cross should have an Specific Scripts Pharmacy on-line account to order the free exams via Specific Scripts. An individual with UnitedHealthcare with OptumRx advantages can organize them via the web Optum Retailer web site.

Ordering exams via insurers’ web sites, nevertheless, can typically imply a wait of some days to weeks earlier than the exams arrive — not superb for somebody who’s sick or has simply been uncovered to the sickness.

“I’m grateful for the access to the tests, and I’m grateful that they’re covered, but it is burdensome, and it really disproportionately affects people that don’t have the time to sink into it or that may not have internet access at home,” Kelly mentioned of the method.

“Families really feel like they’re on their own, and that they need to get the tests in case they need them because you can’t always get them in a pinch,” she mentioned.

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