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March 09, 2020 at 04:57 PM
Health insurers and state insurance regulators are continuing to race to see who can get health insurers into the battle to control the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus first.
(Related: Health Insurers Mobilize for the Covid-19 Fight)
Here’s a look at what some states and insurers are saying about the war against the virus that causes Covid-19 pneumonia.
State Regulators
The California Department of Insurance has issued a bulletin calling for all commercial health insurance providers in the state to waive any co-payments, deductibles, coinsurance amounts, or cost-sharing arrangements that might discourage people from getting tested for SARS-CoV-2.
The department is told insurers to make sure their call center staffers, nurse lines and customer service representatives know about the cost-sharing waivers; to cover all medically necessary emergency care without prior authorization; to protect enrollees against any surprise bills related to SARS-CoV-2 testing; and to cover out-of-network care on an in-patient coverage basis if a surge in SARS-CoV-2 cases overwhelms the in-network providers.
A copy of the bulletin is available here.
The Maryland Insurance Administration has a state-of-emergency proclamation from Gov. Larry Hogan to impose SARS-CoV-2-related requirements on health insurers. The state is requiring health insurers to allow one-time prescription refills, in preparation for a possible quarantine; to educate enrollees about SARS-CoV-2; and to get their provider networks ready to handle a surge in the number of patients with severe cases of Covid-19 pneumonia.
Al Redmer Jr., the state’s insurance commissioner, has issued emergency regulations that require health carriers to waive cost-sharing for any SARS-CoV-2 testing and diagnostic work done in any setting, and to waive cost-sharing for SARS-CoV-2 vaccinations.
A carrier may evaluate a request to use an out-of-network provider for SARS-CoV-2 testing only on the basis of whether the use of the out-of-network provider is medically necessary or appropriate.
Any adverse decisions related to requests for SARS-CoV-2 testing must be handled on an emergency basis.
The Nevada Division of Insurance has adopted an emergency regulation that calls for health insurers to cover SARS-CoV-2 exams and diagnostic tests without imposing any requirements for co-payments or deductibles. Health insurers in the state must cover any available treatments for SARS-CoV-2 infections and Covid-19 pneumonia, and they must cover SARS-CoV-2 testing and care from out-of-network providers if care from in-network providers is not immediately available.
Links to information about the Nevada emergency regulation are available here.
The Oregon Department of Consumer and Business Services has negotiated a voluntary agreement with the state’s main health insurance issuers to waive cost-sharing for SARS-CoV-2 infection testing; in-network provider office visits for SARS-CoV-2 testing; in-network urgent care center visits for SARS-CoV-2 testing; emergency rooms for SARS-CoV-2 testing; and SARS-CoV-2 immunizations.
The Oregon SARS-CoV-2 coverage agreement web page is available here.
Washington State Insurance Commissioner Mike Kreidler has issued an emergency order calling for insurers in the state to waive co-payments and deductibles for SARS-CoV-2 testing; allow a one-time early refill for prescription drugs; and suspend any prior authorization requirements for treatment or testing for SARS-CoV-2 infections.
If an enrollee can’t get in-network SARS-CoV-2 testing, then a plan must let the enrollee get treated by an out-of-network provider “within a reasonable distance” at no additional cost.
Kreidler’s order applies to short-term health insurance policies as well as to major medical insurance coverage, and it is set to stay in effect until May 4.
A copy of Kreidler’s emergency order is available here.
The Wisconsin Office of the Commissioner of Insurance has issued a bulletin asking health carriers to waive SARS-CoV-2 testing cost-sharing, and to review their networks’ ability to handle SARS-CoV-2 cases.
A copy of the Wisconsin bulletin is available here.
Insurers
Here’s a look at what some health insurers are doing, based on the companies’ own announcements, and compilations created by America’s Health Insurance Plans:
Aetna will waive co-pays for all SARS-CoV-2 testing for all insured enrollees, whether the enrollees are in commercial, Medicare or Medicaid plans. Self-insured employers can opt-in. Aetna is also offering zero co-pay telemedicine visits for any reason, and it’s offering its Medicare Advantage virtual evaluation and monitoring visit benefit to all fully insured members.
Anthem will waive prior authorizations and cost-sharing for SARS-CoV-2 testing, and it’s encouraging patients to consider to change to a 90-day supply of their regular medications, from a 30-day supply.
