INSURANCE COVERAGE FOR COVID-19 TESTING

The Coronavirus pandemic has caused upheaval not just for the residents, but also for health insurance providers in the United States. Insurers now have to decide what is covered and what isn’t under their health plans. Many are unable to get back to work because they are uninsured, have insufficient coverage or perhaps not able to afford frequent tests. The high costs of healthcare and lack of publicly funded health insurance make most employees dependent on employer sponsored insurance. Millions have lost their jobs during the pandemic, also losing their insurance coverage at a time when health coverage is especially crucial. People who are uninsured face even greater barriers to seeking medical care as it eats into their savings.

Who is covered?

The Families First Coronavirus Response Act (FFCRA) passed by Congress requires health plans to fully pay for testing deemed medically necessary, i.e, if you are having symptoms, or you have had suspected or direct exposure or you need testing for surgical clearance, insurance will cover all of the testing and office visit. This will apply only if you’ve been referred for a test by a healthcare professional.

Government programmes like Medicare cover tests for Covid-19 at no costs if you have symptoms and if the test is ordered by your doctor or health care provider. If you’re asymptomatic, costs are covered if the test is ordered by a healthcare professional or if you are a resident or patient in a nursing home. Nursing homes are required to test their staff every week to ensure safety of its occupants. Public health researchers emphasize the importance of repeatedly testing nursing home residents and employees, as well as other asymptomatic, but high-risk people. Those who have lost their jobs due to Covid-19 still have coverage options under the Consolidated Omnibus Budget reconciliation Act (COBRA) and Medicaid.

Who is not covered?

As precautionary testing has become common, insurance companies argue that they won’t be able to cover testing as a preventive measure. Testing is considered not medically necessary when performed for public screening purposes to determine the prevalence of Covid-19 infection in the community, congregate settings or other viral diseases.

Insurance companies like UnitedHealthcare, state that benefits will be decided in accordance with the member’s benefit plan. When the tests are not diagnostic or medically necessary, insurers guarantee that they will cover testing for employment, education, public health or surveillance purposes when applicable by law. Currently testing in these settings is not required by law. What concerns insurance companies is that employers might initiate testing for everyone getting back to work. If it is passed as a law and if the government doesn’t intervene, it would cost health care insurers $25 billion a year. 

The Equal Employment Opportunity Commission has issued a statement saying that employers can legally require testing. However, this has not been implemented by many so far. Most just opt for temperature checks and questionnaires about symptoms, exposures and past travels. Insurers like Cigna and others do not cover testing for return-to-work, return-to-school, participation in sports, pre-employment, routine and/or executive physicals, travel, recruitment to armed forces, insurance purposes, disability evaluation and administrative exams.

Pressure is now mounting on insurers, employers and consumers. While insurers argue that the employers should cover the cost of testing, employers claim that they themselves are struggling financially and will not be able to do so. On the other hand, the workers also cannot afford testing especially if it has to be done frequently. 

Check out the Buckhead Medicine website and read our blogs and articles for more information regarding Covid-19. Read about how to get a Covid test if you don’t have health insurance. If you’re going home for the holidays, read our blog on precautions that you can take. 

COVID-19 Update 15: Vaccination

Dear Patient,

I hope this message finds you safe and well. I wanted to give you a brief update on the Pfizer COVID-19 vaccine.

Vaccine Safety and Efficacy

The FDA and the CDC have approved the first of six COVID-19 vaccines for emergency use authorization. The first of these is the Pfizer-BioNTech modified RNA vaccine aka BNT162b2. The FDA recently reviewed the Pfizer randomized clinical trial findings and has determined that this vaccine is safe and effective, and the CDC agrees with these findings. As your medical provider I want you to know that I have also dedicated a significant amount of time reviewing and analyzing the Pfizer vaccine data. I’ve reviewed the following:

  • Pfizer clinical trials protocol – LINK
  • Vaccines and Related Biological Products Advisory Committee Meetings brief and emergency use authorization – LINK
  • Letter of authorization from the FDA – LINK
  • Safety and Efficacy report from the New England Journal of Medicine – LINK

Based on my evaluation of the most current available data, I find that the Pfizer COVID-19 vaccine safety and efficacy profile is very good, particularly when weighed against the current state of the COVID-19 pandemic. Pfizer’s randomized double blind clinical trial has followed the expected scientific rigor and processes that are required for the development of modern day vaccines. This vaccine carries a similar side effect profile seen with other vaccines that we typically administer, including the influenza vaccine and the zoster vaccine. The common side effects include injection site pain and redness, as well as flu like symptoms after the injection. The Pfizer COVID-19 vaccine showed efficacy of 95%, which is excellent. Efficacy is a percent reduction in disease (new infection) risk compared to the unvaccinated group.

There are still some unknowns about this vaccine including the safety profile beyond 2 months post injection. Additionally, we do not know if it is safe in pregnant women, immunocompromised patients, and in people who have had allergic reaction to vaccines in the past or have a history of anaphylaxis. If you fall in any of these categories, please speak with me before you receive the vaccine.

I will be receiving this vaccine as soon as it is available to me and I also am recommending the Pfizer COVID-19 vaccine to all my eligible patients. The Pfizer COVID-19 vaccine is a 2-dose vaccine given 21 days apart and is recommended for persons age 16 years of age and older. Once you are vaccinated please make sure to report any side effects to our office.

Vaccine Availability

The Pfizer COVID-19 vaccine will initially be available to frontline healthcare workers and residents of long-term care facilities. As the vaccine availability increases, vaccination recommendations will expand to include more groups. Our office is working closely with the Georgia Department of Public Health to ensure that we receive vaccines as soon as they are readily available. At this point there is no solid time frame for when this will happen. We anticipate that vaccines will be available more readily at hospitals and pharmacies before they arrive at urgent care centers and doctors’ offices. Rest assured that as soon as vaccines arrive in our office, we will notify all of our eligible patients. Additionally, when we identify facilities that are actively vaccinating specific groups, we will also notify you.
I also would like to recommend that you download the Vsafe app from the CDC, once you are vaccinated, https://www.cdc.gov/…/2019-ncov/vaccines/safety/vsafe.html . This application will be used once you are initially vaccinated to assist in reporting any side effects to the CDC and to help remind you of your second vaccine due date.
While release of the Pfizer COVID-19 vaccine is clearly a momentous event in our history and is one step closer to ending this pandemic, I want you to know that we are still having significant loss of life due to COVID-19 infection. I still strongly recommend that you continue to practice measures that will avoid infection including wearing masks, social distancing, avoiding large crowds, and washing your hands frequently. I do expect once we reach a significant threshold in vaccinating the population, likely around the fall of 2021, hospitalization and death rates will decrease significantly.

Warm wishes during this holiday season,
Dr. Edward Espinosa
Buckhead Medicine
91 W. Wieuca Road, NE
Atlanta, GA 30342
404-257-5585

HOW LONG DO YOU HAVE TO ISOLATE FOR IF YOU ARE EXPOSED TO COVID-19?

Covid-19 has been around for almost a year. While a lot of information keeps coming out on how long you need to isolate, it keeps changing based on new research. Many state level health organizations are working to provide information to curb the transmission of Covid-19. They issue guidelines regarding the spread of Covid-19 and the isolation periods. This varies from person to person depending on the level of infection they have suffered. It ranges from mild, moderate to severely weakened immune systems or immunocompromised. It also depends on when you started showing symptoms or when you came in contact with a person infected with Covid-19. 

IF YOU’VE TESTED POSITIVE FOR COVID-19

According to the CDC, If you have tested positive for Coronavirus and are symptomatic, self isolate for ten days since your symptoms started and 36 hours since your last symptom. However, if you don’t have any signs, quarantine for ten days after you’ve had the test. If you start showing any indications after you have been self isolating, then distance yourself for ten days after your symptoms began. You can stop distancing yourself after ten days if you do not show any signs, have not had a fever for the past three days, you just have a cough and changes in your smell and taste(these can last for weeks even after your infection has gone). After ten days, if you still have any indications like a high temperature, nasal congestion, sneezing, feeling sick or you have diarrhoea you will still have to continue your isolation. Your doctor might still want you to get tested again after your quarantine period to ensure that you are not contagious.

If you were severely ill with Covid-19 you might need to stay home for longer than ten days. It could extend for upto 20 days since the symptoms first started. People who were severely immunocompromised might require testing. Based on your tests, your healthcare professional will tell you if it is safe for you to start being around people.

IF SOMEONE YOU LIVE WITH TESTS POSITIVE

If someone you live with tests positive and they are symptomatic, stay home for ten days after symptoms started. If they do not have any indicators, distance yourself for ten days after they had their test. Again, if they start showing signs of Covid-19 after they have begun isolating, the ten days restarts from when their symptoms began. You can stop quarantining after ten days if you do not show any more signs of an infection. Although it might be difficult, avoid coming in close contact with this person and avoid sharing spaces like the kitchen and bathroom.

IF YOU CAME INTO CONTACT WITH A POSITIVE PERSON

If you come into contact with a person who has tested positive for Covid-19, you will have to quarantine for 14 days after your last interaction with that person. However, if you yourself have had Covid-19 in the past three months and recovered from it, and you do not develop any symptoms, you do not need to stay home.

However mild your infection was and no matter how quickly you recovered, you should continue wearing a mask in public places and maintaining social distance. Reinfection by the virus is very rare but it has happened, so you should always be cautious. 

Check out the Buckhead Medicine website and read our blogs for more information regarding Covid-19. Read our blog on why the CDC keeps changing Covid-19 guidelines and how to get a Covid test if you don’t have health insurance. If you’re planning to travel, read about precautions you can take if you’re going home for the holidays on our blog.