What Does the End of Public Health Emergency Mean to Sonora Quest Patients & Providers?

 

The Public Health Emergency (PHE) declaration issued on January 31, 2020, for the COVID-19 pandemic is ending. Effective May 12, 2023, the end of the COVID-19 PHE will greatly impact costs and accessibility for SARS-CoV-2 (COVID-19) testing. Sonora Quest is here to help you navigate these new policies and support you with the same timely, quality testing solutions we’ve always provided.

While coverage requirements and guidelines for COVID-19 testing may vary, below is a summary of key changes for patients and health care providers to be aware of:

I am/My patient is insured with private health insurance

  • Private health insurance companies are no longer required to provide free COVID-19 tests
  • Many insurance companies are including testing as a benefit, but members will be responsible for paying their copay or a deductible based on their benefit plana
  • If the member uses an out-of-network lab, they may incur additional out-of-pocket costs
  • Retail testing (ie, pharmacy) may not be available and patient-initiated testing may not be covered
  • Many insurance companies are requiring patients to be symptomatic in order for testing to be covered as a plan benefit.a Including relevant ICD-10 codes associated with symptoms may better inform coverage decisions

a Coverage may vary within individual insurance plans.

I am/My patient is not insured

  • Uninsured patients without a provider’s order will still have access to zero-cost testing through the CDC’s Increased Community Access to Testing (ICATT) program.
  • ICATT no longer covers high-risk individuals (immunocompromised, pregnant, etc.) without symptoms or exposure as of May 12, 2023. Patients must be symptomatic and/or are asymptomatic with suspected or known exposure.
  • Physicians with uninsured patients in need of COVID-19 PCR/Diagnostic testing should refer them directly to sonoraquest.com/covid-testing to go through the ICATT qualification process. If an uninsured patient presents with a physician’s order for COVID-19 PCR/Diagnostic testing or has not gone through the screening process online, they will not be eligible for participation in the no-cost testing program and may be charged for their testing. 

To learn more about ICATT and eligibility visit COVID Testing.

I am/My patient is covered under Medicare

  • Medicare enrollees may still be eligible for free testing for a limited time
  • Testing must be ordered by a healthcare provider

I am/My patient is covered under Medicaid

  • State Medicaid programs must provide free COVID-19 tests through September 2024, after which time coverage will vary by state

Other Post-PHE COVID-19 Testing Questions

 

Will Sonora Quest still offer COVID-19 testing?

We are committed to supporting our community with a complete portfolio of COVID-19 tests, including semi-quantitative antibody testing, gold-standard PCR (molecular) laboratory testing, and respiratory combination testing, which use a single specimen to test for COVID-19 and other respiratory pathogens (RSV and flu A/B). Coverage scenarios will vary by health plan and some eligibility requirements apply.

  • A health care provider’s order is necessary for patients to receive any COVID-19 combo testing. These tests are not available through My Lab ReQuest or ICATT.
  • COVID-19/flu is recommended for average healthy adults, while COVID-19/Flu/RSV is recommended for pediatric patients, the elderly, pregnant women, the immunocompromised, or those that have other underlying health concerns.
  • Providers should include all symptoms and conditions through ICD-10 codes, which will be very important for health plan decisions on coverage for each patient.

 

Where can COVID-19 testing be accessed?

Sonora Quest is committed to serving the Arizona community with the same quality COVID-19 collection and testing we have had since the pandemic began. Though COVID-19 testing may not be as easily accessible through retail/pharmacies, patients can still visit SonoraQuest.com/Appointments for a list of nearly 60 Patient Service Center (PSC) locations that provide COVID-19 collection, including select locations with carside collections. Note: Sonora Quest PSCs located inside Safeway stores do not provide COVID-19 testing.


Is COVID-19 testing still able to be self-ordered through My Lab ReQuest?

Yes, Sonora Quest will still provide self-ordered COVID-19 testing for gold-standard PCR (molecular) laboratory testing and semi-quantitative antibody testing. Sonora Quest will determine whether the claims for your testing can be submitted to your insurance or to ICATT if you are uninsured.  All patients can still order self-pay COVD-19 testing through My Lab ReQuest without a health care provider’s order for $116 (PCR test) or $81 (antibody test) by visiting MyLabReQuest.com.

However, the respiratory combination COVID-19 testing (COVID/Flu and COVID/RSV/Flu) is still not available through My Lab ReQuest or ICATT. See MyLabReQuest.com for our complete suite of self-ordered tests.

References

  1. CMS. CMS waivers, flexibilities, and the transition forward from the COVID-19 public health emergency. February 27, 2023. Accessed March 27, 2023.  https://www.cms.gov/newsroom/fact-sheets/cms-waivers-flexibilities-and-transition-forward-covid-19-public-health-emergency
  2. Cox C, Kates J, Cubanski J et al. The end of the COVID-19 public health emergency: details on health coverage and access. KFF. February 3, 2023. Accessed March 28, 2023.  https://www.kff.org/policywatch/the-end-of-the-covid-19-public-health-emergency-details-on-health-coverage-and-access/
  3. Cox C, Kates J, Cubanski J et al. Commercialization of COVID-19 vaccines, treatments, and tests: implications for access and coverage. KFF. February 13, 2023. Accessed March 28, 2023.  https://www.kff.org/coronavirus-covid-19/issue-brief/commercialization-of-covid-19-vaccines-treatments-and-tests-implications-for-access-and-coverage/