Hong Kong has unfortunately been hit by the third wave of the COVID-19 pandemic with a daily surge of over 100 cases . The uncertainty of whether one has got infected without knowing it has left many people jittery. The fear is highlighted with a number of reported asymptomatic infections, which urged private hospitals to take an even more cautious approach to avoid developing outbreaks within their premises.
Not long ago, some private hospitals in Hong Kong gave strong advice to their patients to test for SARS-CoV-2 72 hours prior to a medical treatment, and only those with negative results will be admitted. With such arrangement, the first question asked by many patients and doctors is whether the COVID-19 testing is reimbursable by health insurance?
Justification on medical needs is key reason to determine
While insurers may have different treatments on the issue, but in general, they will evaluate why such tests are needed. In our organization, if the reason of the test is to acquire travel permissions, it cannot be regarded as medically necessary and therefore will not be reimbursed; on the other hand, as a prerequisite for hospital admission, such tests would be eligible for the claims.
Tests for hospital admission screening are hardly novel: for patients having stayed in a public hospital recently and then subsequently admitted to private ones, they are usually required to be examined for Staphylococcus aureus or other multi-resistant bacteria. This is because chances of catching such germs are higher in public hospitals, and some patients may exhibiting no symptoms at all. As part of infection control, private hospitals must identify such carriers and, if necessary, isolate them, to prevent any outbreak that could potentially harm other patients and health personnel.
COVID-19 admission screening sounds reasonable
For the same reason, since many COVID-19 patients are without symptoms, private hospitals also need to perform admission screening in order to avoid disastrous consequences.
Although such tests will incur higher costs for insurers, they are done with a sound and medically necessary reason. Therefore, reasonable and prudent insurers are happy to indemnify them.