Will my COVID-19 Test Home Collection Kit DTC be covered by insurance?
Everlywell is not a healthcare provider nor a laboratory and therefore cannot bill your health insurance directly. However, this test may be covered by your insurance provider*, according to federal law. In addition, this product is covered by participating FSA and HSA plans.
*Everlywell is not enrolled in the Medicare program and this test is ineligible for Medicare reimbursement.
Once your test is completed, Everlywell will provide an itemized receipt that will contain the information you will need to apply for reimbursement directly from your health insurance provider including:
- Your patient information
- The approving physician, including diagnostic codes
- The performed services, including procedure codes
- Itemized costs for lab tests and physician oversight
- EIN (also known as Tax ID Number)
- NPI #
Steps to file for reimbursement:
- Once you’ve been notified that your COVID-19 test results are available, visit results.everlywell.com
- Click on your COVID-19 test results, then select “View Documents” from the top right toolbar, then click “Itemized Receipt” to download the PDF.
- Submit the itemized receipt through your healthcare insurance provider’s normal claims submission process. If you have questions about completing that process, we recommend reaching out to your insurance provider directly.
Note: Each COVID-19 Test Home Collection Kit DTC includes the option for a telehealth consultation by PWNHealth. An $8.00 fee for physician oversight of the test will be listed as a line item on your itemized receipt. The terms and conditions of coverage for COVID-19 services and testing vary by insurance plan, and the COVID-19 services offered by PWNHealth may not be eligible for coverage or reimbursement.
The Centers for Medicare and Medicaid Services (CMS) have indicated that at-home collection tests, such as the one Everlywell provides, must be covered by insurers and health plans when the test is ordered by an attending health care provider who has determined that the test is medically appropriate for the individual based on current accepted standards of medical practice and the test otherwise meets the statutory criteria in section 6001(a)(1) of the FFCRA. Consistent with section 6001 of the FFCRA, this coverage must be provided without imposing any cost-sharing requirements, prior authorization, or other medical management requirements. All Everlywell COVID-19 Test Home Collection Kits DTC are ordered by independent physicians licensed to practice medicine in the state of the test-taker, based on results from a screening questionnaire indicating that the test is medically appropriate for the individual.
There is generally no limit on the number of tests that are covered if ordered or administered by a healthcare provider. This would include the Everlywell COVID-19 Test Home Collection Kit DTC. You can read more about reimbursement for that test here.