Exton lab conducting more tests.
Exton lab conducting more tests; most patient costs to be absorbed
More public health labs across the nation can now test for the coronavirus, COVID-19, and capacities are expanding, but there is still just one testing site for samples taken in Berks County and southeastern Pennsylvania.
Even with capabilities expanded, not every person who wants to be tested can be accommodated. As late as Wednesday afternoon, all 16 cases in Pennsylvania are traceable and no “community spread” cases have been documented.
The Centers for Disease Control and Prevention reported that, as of Tuesday night, there were 79 public health labs across the country performing COVID-19 diagnostic tests. More commercial labs are in the process of implementing testing capabilities.
Samples from Berks and southeastern Pennsylvania are tested at a state lab in Exton, Chester County.
The state will pick up the tab for testing in Exton, but private tests, when they become available, would be billed to a private insurance carrier. Many carriers have agreed to pay 100% of that cost.
The most recent figure available was that the state lab can perform 150 tests daily. The capacity has been increasing since testing began there earlier this month.
Though the increased testing capabilities mean a wider group of patients can be tested, the Centers for Disease Control and Prevention’s criteria must be met ahead of a test.
“We can’t test everybody who may want to be tested,” said Dr. Debra Powell, chief of the section of infectious diseases, and medical director of infection prevention at Reading Hospital.
Symptoms for the virus are fever, cough and shortness of breath, and range from mild symptoms to severe illness and death. These symptoms can appear two to 14 days after exposure.
Taking the test
If someone is experiencing symptoms and believes he or she may have been exposed to or have COVID-19, the first step is to call the doctor. This ensures the doctor can take the appropriate measures should the patient need to be seen in person, officials said.
“The first thing we ask everybody at the time of registration is, ‘Have you traveled and what symptoms do you have,’ “Powell said. “If they have respiratory symptoms and a travel history, then we have additional questions we ask them.”
Testing is not done at the hospital, but samples are taken on site, then sent to Exton. It’s not clear if patients have gone to hospitals in Berks to seek testing.
Prior to taking the samples, the hospital checks with the Pennsylvania Department of Health to determine if the patient meets the criteria for testing due to the limited number of tests that can be performed.
“We call the Department of Health and have a discussion regarding the patient’s history and their information to see if they meet the parameters for testing,” said Marie Keim, director of epidemiology and infection prevention at Tower Health. “Then we would only be able to take those samples after we’ve received that approval from the Department of Health. That’s a critical piece of the process.”
Two of the determining factors are whether the patient has had close contact with a laboratory-confirmed COVID-19 patient within 14 days of symptoms appearing, or a history of travel from effected nations — including China, Iran, Italy, Japan and South Korea — within 14 days of symptoms appearing.
If a patient meets the criteria, samples are taken from the nose, throat and lungs.
According to Powell, results from tests performed at Exton laboratory are available in about four to five hours. A positive test means a patient can then be treated at a hospital. Treatment is supportive care for the symptoms.
A patient with significant symptoms would likely be kept at the hospital while the samples are being tested.
Results from laboratories other than through the CDC are considered presumptive positive until the CDC tests the sample. According to Dr. Rachel Levine, secretary of health, no presumptive positive cases have been wrong following CDC testing.
Who pays?
As the testing capabilities have expanded, there have been concerns of who would pay and the cost for testing. Each test costs $150 to $200, according to the Department of Health.
Testing done at the state lab is being covered by the state at no cost to the patient. Testing done at commercial labs would be billed to the patient’s insurance.
Gov. Tom Wolf announced Monday that all major health insurers providing medical coverage in the state will cover medically appropriate coronavirus testing.
“The opportunity to conduct in-state testing without putting the financial burden on consumers allows us to better identify those at risk,” Levine said in a press release. “Removing the financial consumer obligations associated with tests and care will allow more individuals with symptoms to come forward and be tested.”
The state’s major health insurers taking part include Highmark, UPMC Health Plan, Geisinger, Independence BlueCross, Capital Blue Cross, Aetna, Cigna, UnitedHealthcare, Pennsylvania Health & Wellness and Oscar.
Testing will be done without co-pays, deductibles or cost-sharing for patients. Treatment associated with coronavirus will also be covered, but there might be a nominal co-pay.
Patients with Medicaid coverage and the Children’s Health Insurance Program (CHIP) will not be expected to pay a co-pay for any testing related to the virus.
There may be significant limitations for people with excepted benefit policies; short-term, limited duration health insurance coverage; or health care sharing ministries. Self-funded coverage may also have different limitations.
The Pennsylvania Insurance Department is encouraging health insurers to coordinate with the business they administer on behalf of employers who self-fund their health benefits to ensure consistency in access across all forms of coverage.
Insurers are required to cover emergency services for an emergency medical condition at in-network levels. Services include transportation, and inpatient and outpatient services needed to evaluate or stabilize a patient. Medical assistance also covers emergency services, but may include a nominal copay for certain services.
No one will be denied treatment or services if any co-pay is not affordable at time of treatment or service, officials said. The insurance provider may send a bill for the co-pay amount.
Limiting impact
On Tuesday, the insurance department in collaboration with the Department of Health announced the submission of a notice to the Pennsylvania Bulletin outlining proactive steps and recommendations for individuals and major health insurers
to help mitigate the potential impact of the virus.
Recommendations for insurers provided in the Notice Regarding Coronavirus (COVID-19) include:
• Providing access to accurate information, informing insureds of available benefits and quickly responding to inquiries about coverage.
• Providing telehealth delivery of services instead of in-person health care services and being prepared to meet any increased demand for that means of delivery.
• Verifying provider networks are adequate to handle a potential increase in the need for health care services related to the virus.
• Easing preauthorization requirements so they are not a barrier to access necessary treatment for the virus, and being prepared to expedite utilization review and appeal processes for services related to the virus.
• Easing access to prescription drugs, making expedited formulary exceptions, and permitting the temporary use of outof-network pharmacies (at in-network cost-sharing) in the event of medication shortages at in-network pharmacies.
Anyone with questions on coverage should contact his or her insurance provider, officials said.
The Insurance Department has a team available to answer questions about insurance coverage and benefits at 877-881-6388. The department can also be contacted in the event of an unexpected bill related to the coronavirus.
Updated information on the virus, including insurance coverage questions, is available at health. pa.gov.