We use the Quidel CLIA waived rapid covid 19 and the combo rapid COVID19/Flu A & B tests in our office in Texas. I’m wondering if anyone else is using these tests and if any commercial insurance companies are reimbursing below your cost on them. The CPT codes are 87426 and 87428 respectively.
Thank you!
Hello.
We have one commercial payer, United Healthcare, that is paying less than cost for the Quidel CLIA waived rapid COVID19 test. We are not using the combo test yet since.
I have written a letter to our provider rep and to contracting. The letter was ignored.
According to this article, we are not the only ones complaining.
“Doctors who have complained to UnitedHealthcare and other health plans, however, say they’ve been offered little recourse. One was told it wasn’t an issue that any other doctor had raised. Another was directed to find a supplier with a lower price.”
UHC lab reimbursement contracts is a percentage of Medicare. Which brings the reimbursement below cost. Other insurances and Medicaid are paying at a 100% of Medicare or close to it.
I have a lot of issues with UHC, and I am always told that nobody else is raising the same issues. Rather than finding resolutions, UHC tries to make us seem like we are just complainers.
Please keep me updated if you make any progress.
UnitedHealthcare is also the plan that is not covering our cost of the test. My Quidel rep provided a couple of form letters and UnitedHealthcare’s directors of reimbursement policy and provider contracting. I contacted them with the letters, CMS website’s allowed charges for the 2 tests, our reimbursement amounts and our costs. I haven’t heard back from either of them. I went to the UnitedHealthcare link and found an email for the Network Management Resource Team. After a couple of emails back and forth with them, they provided our Network account manager’s name, email and phone number. I have emailed all of my supporting documentation for a rate increase. I just emailed her 5/10/21, so I haven’t received a response back yet.
I’ve also contacted the Texas Medical Association who said they have been contacted by multiple providers’ offices about the same issue. TMA has contacted UnitedHealthcare, but no response as of a couple of days ago.
I will post again if I receive any response from them.
Thanks for responding.
We use a different brand, but have the same issue with UHC. For a short time last year, we got cost covered. We are now doing an in-office PCR test with the same problem…only with UHC.
I had sent an email with a copy of our Covid rapid test invoice to UHC provider contracting and provider rep on 2/4/21 and 5/8/21. No response. It is not unusual for UHC to avoid responding when they do not want to deal with an issue. Then they hope we fade away and give up. Look forward to your response from the TMA.
I would contact the Insurance commission with all the letters and responses or lack of responses from United Healthcare and send a copy of that letter to United Healthcare.
THis will usually work wonders once they know the insurance commission will probe them.
Hope it helps keep me posted
We have received our kits for the combo COVID19 and Influenza A & B test, but have not started using them yet. Are you billing this with 3 units or with -59 modifier like 87428-QW + 87428-QW,59 + 87428-QW,59?
We use the Roche Liat, Flu A& B/Covid combo test and bill 87636. No modifier has been needed. Only bill one unit as this code cover all these tests.
Thank you! We have ordered the BD Veritor tests; CPT 87428.