Are your covid test results shared with your insurance?

COVID test results from self-tests performed by yourself or COVID-19 PCR tests ordered by you are not shared with your insurance provider.

When your doctor orders a COVID test, the result may be shared with your insurance when it is positive and leads to further follow-up appointments, tests, and treatments. This is done because insurance companies need to see the medical necessity of the follow-up procedures and tests to authorize payments.

However, not every test detail is shared. Medical providers share just enough information with the insurance companies for the latter to authorize payment. In general, information about individuals’ health is protected by HIPAA (Health Insurance Portability and Accountability Act).

Data privacy and HIPAA regulations

HIPAA states that you have the right to your health information and how it is used.

You have the right to access your health information from your medical providers. Once the request has been made, your providers have 30 days to send it to you. You have the right to check this information for errors such as incorrectly noted test results. The providers must correct the error within 60 days. If they disagree with you regarding the correction, they still have to make a note of your comment in the health record within 60 days. You have the right to see which entities this information has been shared with. You can also ask that your information not be shared with specific people, groups, or companies.

Sometimes, the providers may not accommodate a specific request about not sharing your health information when the lack of disclosure can demonstrably and negatively affect your care.

Also, not sharing information with your health insurance company could result in them not covering certain charges. However, if you are willing to pay for drugs or treatments in full, then you can request that information not be shared with your insurance company.

Health insurance companies are covered entities under HIPAA which means that they must follow HIPAA regulations.

HIPAA rules impact health insurance companies in the following ways:

Data privacy. Your health insurance company has your health information to the extent necessary to pay for procedures and/or prescriptions. They will know about the tests and procedures you undergo and the medications you are taking. But they won’t have access to the details such as your doctor’s notes.

Data security and breach notification. Health insurance companies and all medical providers with access to your health information must take steps to ensure that the data is safe. If a data breach happens, they must inform you about what information was accessed or stolen during the breach.

In general, health insurance companies have to ask for your permission to access your medical information and they generally request it when you apply for coverage. Then they obtain information as a series of codes referring to your general health. This is for underwriting purposes only. Under the Affordable Care Act, this information cannot be used to discriminate against someone by refusing to cover them or jacking up their rates.

When COVID test results may be shared with other entities

Due to the public health emergency caused by COVID-19, some of the HIPAA regulations were temporarily rolled back. Hospitals and medical providers were required to report positive rates to the HHS to keep track of the progression of the pandemic. Disclosures about personal health information related to COVID-19 status were also made on an as-needed basis to first responders such as the police and paramedics so that they could take adequate precautions to protect themselves from the infection. However, emergency measures are being relaxed now as the emergency has officially ended. Effective May 1, 2024, the CDC no longer requires hospitals to report COVID-19 hospital admissions, hospital capacity, or hospital occupancy data to the HHS.