Americans concerned about bioterrorism now have one less thing to worry about. Many health insurers say if your doctor orders anthrax tests for you, your insurance will pay for them.

Aetna U.S. Healthcare, CIGNA, Kaiser Permanente, and Oxford have all said they will cover anthrax testing and treatment when "medically appropriate." Additionally, the U.S. Department of Health and Human Services (HHS) says Medicare covers anthrax testing "when reasonable and necessary and ordered by a physician."

"When people are so scared, we need to make sure they have access to physicians, treatment, and testing when they are part of an affected population," says Mohit Ghose, spokesman for the American Association of Health Plans (AAHP).

AAHP communicates by e-mail with the medical directors of its member health plans to disseminate the latest information released by the Centers for Disease Control and Prevention (CDC) and HHS, according to Ghose.  Ghose says the updates underscore just how quickly health care professionals must adapt to constantly evolving scenarios, including who should be tested and when.

Doctors on the front line

While federal authorities have urged more than 10,000 Americans — mostly postal workers in Florida, New Jersey, New York, and Washington, D.C. — to take anti-anthrax antibiotics, attempts to dissuade the public from stockpiling the medications have met with mixed results. Following reports of anthrax cases, some family physicians came under intense pressure from patients to prescribe the drug.  That prompted some state medical societies, such as the California Medical Association, to draft letters to encourage their member physicians to "just say no" to inappropriate patient requests for anthrax-fighting drugs.

Additionally, several major California health insurers, including PacifiCare Health Systems, now require a doctor's explanation and pre-approval by the health plan before they'll pay for more than a 14-day supply of Cipro, according to PacifiCare spokesman Ben Singer.

Ghose says doctors are on the frontline in the battle against bioterrorism. "They are the people on the ground," he says. "We can only monitor what happens. They are providing the actual care."

Although doctors must decide whether anthrax testing is appropriate on a case-by-case basis, health plan officials point out doctors are not working in a vacuum without guidelines. The CDC has specific recommendations about how physicians should treat patients both with and without symptoms and with or without known exposure to anthrax. Those guidelines have been summarized on the New Jersey Health Department's web site.

For people suspected of contracting anthrax, laboratory testing is essential to diagnosis, according to the CDC. These tests, which most health insurers say they will pay for if ordered by your doctor, might include:

• Cultures of blood and spinal fluid (should be done before antibiotic treatment has been initiated).
• Cultures of tissue or fluids from affected areas.
• Microscopic examination of tissue.
• PCR (polymerase chain reaction) test that amplifies trace amounts of DNA to document the presence of anthrax bacteria.

According to the CDC, one of the most common tests conducted during an anthrax exposure investigation is a nasal swab culture. This test is used to detect anthrax spores in your nose. Nasal swabs don't determine if you have anthrax, but they might show if you have been exposed. The nasal swab cannot rule out exposure to anthrax. In other words, a negative nasal swab test does not mean exposure has not occurred. For this reason, nasal swab cultures must be used in conjunction with one or more of the tests listed above. Nasal swab tests are used mainly to help investigators assess the possible level of exposure, not for medical treatment of the affected individual.