Excellus BlueCross BlueShield
Contact Us
More Topics
COVID-19 Health Resources >
COVID-19 Health Resources >
COVID-19 Testing Coverage

The health plan provides coverage in full for diagnostic/viral testing as well as antibody testing that is determined to be medically appropriate for the diagnosis and treatment of an individual by an attending provider as evidenced by an order from the attending provider.

  • The tests must be FDA approved or the subject of an emergency use order request and the lab performing the testing must be appropriately certified.
  • This policy on COVID-19 testing applies to members in all lines of business: commercial plans, Medicaid Managed Care plans and Medicare Advantage plans.
  • Testing that is ordered or performed solely for purposes of pandemic control or re-opening the economy, and not based on a determination by an attending provider that the test is medically appropriate for the diagnosis and treatment of an individual member, is not covered. This includes tests performed on an asymptomatic individual solely to assess health status as required by parties such as a government/public health agency, employer, school, or camp.
 COVID-19 Viral and Antibody Testing Policy
COVID-19 Testing Coverage FAQ for Commercial, Medicaid Managed Care and Medicare Advantage Plan Members

What are the different COVID-19 tests?

There are two primary types of tests associated with COVID-19. The diagnostic/viral test is for the purpose of diagnosing and treating an active COVID-19 infection. It is recommended for use in individuals with COVID-19 symptoms or a known or suspected exposure to COVID-19. The antibody test is for the purpose of determining whether there was a past COVID-19 infection.

What are the standards that apply to these tests for them to be considered for coverage?

We provide coverage in full for diagnostic/viral testing as well as antibody testing that an attending provider determines is medically appropriate for an individual as evidenced by an order from the attending provider. These tests must be FDA approved or the subject of an emergency use order request and the lab performing the testing must be appropriately certified (under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and applicable New York state law and regulation) to be considered for coverage.

Can I get my test done at my local pharmacy and have my insurance pay for it?

If an attending provider, including a pharmacist, determines that the test is medically appropriate for you and orders the test, the test can be performed at your local pharmacy if the pharmacy has received approval to conduct such testing under the waiver authority of CLIA and is approved by New York State as a limited service laboratory.

I am curious about my own immunity to COVID-19. If I ask my doctor to order the antibody test for me, will it be covered by my health insurance [health benefits plan]?

The NYS Department of Health has issued recommendations to health care providers for determining when a test is medically appropriate. Testing when ordered upon the request of a member solely to facilitate the member’s desire to self-assess COVID-19 immune status is not a recommended basis for testing and is not covered.

If I order a home testing kit on my own, will you reimburse me for that?

No. No testing is covered without an attending provider’s determination that the test is medically appropriate for an individual, as evidenced by an order.

If my employer requires me to have a test, will my insurance cover the cost?

No. Testing that is ordered or performed solely for purposes of pandemic control or re-opening the economy, and not based on a determination by an attending provider that the test is medically appropriate for the diagnosis and treatment of an individual member, is not covered. This includes tests performed on an asymptomatic individual solely to assess health status as required by parties such as a government/public health agency, employer, school, or camp.

If I go to an urgent care center, can I get my test done there and have it covered?

For a test to be covered through your insurance, it must be prescribed by an attending provider who has determined through an individual assessment that a test is medically appropriate for you. The NYS Department of Health has issued guidance to health care providers for determining when a test is medically appropriate. Testing when ordered upon the request of a member solely to facilitate the member’s desire to self-assess COVID-19 immune status is not a recommended basis for testing and is not covered.

Do these rules apply to members of Medicaid managed care or Child Health Plus?

Yes.

Do these rules apply to members of Medicare Advantage plans?

Yes.
If you believe you may have symptoms of COVID-19, visit the Centers of Disease Control and Prevention's website for an updated list of symptoms and other resources.
If You Suspect You May Need Testing:
  1. Do not go directly to any doctor’s office, emergency room or urgent care center and practice social distancing
  2. Call your primary care doctor first
  3. A telehealth visit using your smartphone, tablet, or computer is also an option for initial screenings. Note: Due to high call volumes, wait times may be longer than usual.
  4. You can contact your local county health department for testing options if you don’t have a primary care doctor.
Learn about Telemedicine and Schedule Appointment
No-Cost Telehealth Visits During the State of Emergency

To help alleviate the burden on provider offices, urgent care centers and hospitals, telehealth visits will be covered at no cost for most members through September 9, 2020 (effective March 13, 2020).

You should ask your provider in advance if they are equipped to conduct telehealth visits via telephone, e-mail, or video chat.

Some common conditions for telehealth visits include:

  • Adults: allergies, cold and flu, ear infections, fever, headaches, joint aches and pains, nausea and vomiting, pink eye, rashes, sinus infections, urinary tract infections; behavioral health conditions such as addiction, stress, depression, and PTSD.
  • Children: cold and flu, constipation, earache, fever, nausea and vomiting, pink eye
  • Certain conditions requiring specialized care such as dermatology, acute chiropractic care, and nutrition consulting can also be treated with a telehealth visit. Check with your specialist to see if they offer this option.

When your doctor isn’t available, telemedicine may be an option for you. Whether you need a consultation for acute, non-emergency conditions, or someone to talk to during a challenging time, our partnership with MDLIVE gives you convenient access to medical and behavioral health care 24/7/365 from the comfort of your home. Note: At this time MDLive is unable to order COVID-19 tests. Please contact your doctor or local county health department if you believe you have COVID-19 symptoms.

Learn about Telemedicine and Schedule Appointment
COVID-19 Health Information

Given that the COVID-19 situation is rapidly evolving, the best resources for up-to-date health information are:

Recommended Precautions from the CDC

The U.S. Centers for Disease Control and Prevention recommends taking everyday preventive precautions to help prevent exposure to this virus and others like it by:

  • Avoiding close contact with people who are sick.
  • Not touching your eyes, nose or mouth.
  • Staying home when you are sick.
  • Covering your cough or sneeze with a tissue and throwing the tissue in the trash.
  • Cleaning and disinfecting frequently touched objects and surfaces using a regular household cleaning spray or wipe.
  • Following the CDC’s recommendations for using a facemask.
  • Washing your hands often with soap and water for at least 20 seconds if hands are visibly dirty and especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol.

Practicing good health habits every day helps to keep our community healthy.

Stay Informed: Create a Member Account
The best way to stay informed and have access to your coverage is online. Let’s get you set up online today. For help or questions with your insurance plan, call the number on your Member Card for personalized care, or contact us.
Contact Us

Copyright © 2020 Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association. All rights reserved.

Terms of Use | Web Privacy Policy | Accessibility Statement

Y0028_7182_C

FacebookTwitterLinkedInYoutubeInstagramPinterest