I have Aetna Student Health Insurance (Open Choice PPO) in New York. I went to an urgent care center in California to get a COVID-19 antigen test in mid-January. I’m 21, have no income, zip code is 10458.
I have yet to receive a bill from my provider, however, I’ve received an EOB statement from Aetna. The EOB statement says that the urgent care center applied codes 99211 (for the urgent care visit) and 87426 (for the SARS-CoV-2 antigen test). (I’ve pasted the full descriptions for each code below.) Initially, Aetna imposed cost-sharing on 99211. However, they said that they would correct the 99211 claim to be covered by Aetna at 100%. But they’re still imposing cost-sharing for 87426. I sent a message to Aetna asking them why they’ve imposed cost-sharing for the antigen test, and they said that 87426 is not a code on the “liberalization list” (whatever that means), so they will not cover the 87426 at 100%.
However, Aetna have stated that they are waiving member cost-sharing for diagnostic testing related to COVID-19. In addition, in response to the question “As new FDA COVID-19 antigen tests, such as the polymerase chain reaction (PCR) antibody assay and the new rapid antigen testing, come to market, will Aetna cover them?”, they have stated that they will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. I believe that the antigen test used by the urgent care center that I visited has received an Emergency Use Authorization.
What should I do for Aetna to cover the entire cost of the antigen test?
99211 – Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional.
87426 – Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g. SARS-CoV, SARS-CoV-2 [COVID-19]).
submitted by /u/naoyao
[link] [comments]I have Aetna Student Health Insurance (Open Choice PPO) in New York. I went to an urgent care center in California to get a COVID-19 antigen test in mid-January. I’m 21, have no income, zip code is 10458. I have yet to receive a bill from my provider, however, I’ve received an EOB statement from Aetna. The EOB statement says that the urgent care center applied codes 99211 (for the urgent care visit) and 87426 (for the SARS-CoV-2 antigen test). (I’ve pasted the full descriptions for each code below.) Initially, Aetna imposed cost-sharing on 99211. However, they said that they would correct the 99211 claim to be covered by Aetna at 100%. But they’re still imposing cost-sharing for 87426. I sent a message to Aetna asking them why they’ve imposed cost-sharing for the antigen test, and they said that 87426 is not a code on the “liberalization list” (whatever that means), so they will not cover the 87426 at 100%. However, Aetna have stated that they are waiving member cost-sharing for diagnostic testing related to COVID-19. In addition, in response to the question “As new FDA COVID-19 antigen tests, such as the polymerase chain reaction (PCR) antibody assay and the new rapid antigen testing, come to market, will Aetna cover them?”, they have stated that they will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. I believe that the antigen test used by the urgent care center that I visited has received an Emergency Use Authorization. What should I do for Aetna to cover the entire cost of the antigen test? 99211 – Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. 87426 – Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g. SARS-CoV, SARS-CoV-2 [COVID-19]). submitted by /u/naoyao [link] [comments]Read Morer/HealthInsurance