Local health insurers, responding to new directives from the state and federal governments, are changing their coverage policies, paying for the cost of testing and treatment of COVID-19 for members and waiving copays and cost-sharing for testing ordered by a doctor.
BlueCross BlueShield of Western New York, Independent Health Association and Univera Healthcare all issued new guidance for members that is posted on their websites regarding medical care for COVID-19.
Under the changes announced by the insurers, the companies will now pay for the diagnostic test for members that meet the CDC guidelines for testing, with no copay, deductible or other cost-sharing.
That applies to fully insured commercial plans, administrative-service-only plans and Medicare Advantage plans, including with Health Savings Accounts. Medicaid also has no cost-sharing for testing or treatment. The state Essential Plan, Child Health Plus and HARP are also included.
Pre-authorization is not required, but all tests still require a doctor's referral.
"A test for COVID-19 is no different than any other test a patient might get," said Dr. Anthony Billittier IV, chief medical officer for Independent Health, and former Erie County health commissioner. "Individuals can’t order their own test."
Univera said high-deductible health plan members also will not be responsible for copayments, coinsurance and deductibles for COVID-19 testing even if the deductible has not been met, based on guidance from the Internal Revenue Service.
The new policies are consistent with the guidance and directives of the state and federal governments, including the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid.
The change could have a big impact on people who think they might need to be tested for the virus, added Dr. Thomas Schenk, BlueCross BlueShield's senior vice president and chief medical officer.
"That might be a true barrier to people and having removed that, I think, should be bringing people to care more quickly," Schenk said.
He acknowledged, though, that the coronavirus test is still not easy to get.
"As a physician, I'm very concerned that tests have not been widely available," he said. "Had we had more widespread testing with fewer barriers to trigger a test, we would have had a better opportunity to think about this on an outbreak basis" rather than a pandemic.
At the same time, the state Department of Financial Services issued an emergency order Tuesday, requiring health insurers to waive cost-sharing for in-network telehealth visits. That means no copayments, coinsurance or annual deductibles, eliminating financial and regulatory barriers while encouraging doctors and patients to use electronic information and communication – such as telephone, video or online services – to deliver health care remotely from a different location than the patient.
The directive follows an announcement on Saturday by Gov. Andrew Cuomo to waive copays for telehealth, whether or not it's related to coronavirus and COVID-19.
"This not only applies for COVID-19, it applies for any other covered health care services including mental health and substance use disorder treatment needed by the consumer, ensuring access to quality, affordable care right in their own home,” said Superintendent of Financial Services Linda A. Lacewell.
The state agency said the goal is to get New Yorkers to seek medical attention from home instead of going to a hospital or doctor's office for issues that might not be related to COVID-19, "ultimately reducing strain on the healthcare system and preventing further spread."
“With the COVID-19 pandemic spreading throughout our state, a simple act like going to a doctor’s office, may inadvertently expose you or others to the virus," said Dr. Howard Zucker, state health commissioner.
Industry research firm AISHealth, citing trade group America's Health Insurance Plans, said more than 40 different health insurers have unveiled new coronavirus-related policies, offering some or all of the same benefits that Western New York's carriers are doing. Self-insured plans – in which employers control the plans, which are administered by insurers – are governed by federal law, so the benefits and terms can vary from one employer to another.
"It’s constantly being updated, so people should keep checking back," said Univera spokesman Peter Kates.
Even before the state issued its order, BlueCross BlueShield and Independent Health had already waived deductibles, copays and cost-sharing for telemedicine visits, and urged members to use telehealth or telemedicine to connect with a doctor before going into an office, citing CDC and state guidance.
The goal is to "alleviate the need for office visits when appropriate, and to minimize patient-to-patient exposure of illness," according to Independent Health, which also offers a "teledoc" service as a backup for physicians who "don't have the technology or capacity to answer all their calls," Billitier explained.
“Our physicians are a critical partner to ensure care and treatment for our members and we support and encourage their use of telehealth and telemedicine for patients,” said Dr. Michael Cropp, Independent Health's CEO.
Independent Health is also now reimbursing its providers on a higher fee-for-service level for the telehealth visits, instead of just a flat fee for the number of such visits, as was the standard practice previously. That's also a change from a prior system years ago, where providers only got paid at all if a patient came into the office.
BlueCross BlueShield also said it would waive the deductible and cost-sharing for all visits to a doctor's office, urgent care or emergency room for diagnostic testing – but not for ongoing treatment – for its commercial, self-insured and Medicare Advantage plans.
And BlueCross BlueShield urged its members to get a 90-day supply of any current prescriptions by using their mail order benefit when possible. However, those members with only one-quarter of their current prescription remaining should go to retail pharmacies for refills, as CDC recommends.
Univera said in-network office, urgent care and emergency visits resulting in a test and treatment are also covered at no extra cost, and out-of-network care will be covered if no in-network provider is available. It also said it will "implement early refill overrides" for members living in areas with a state of emergency, and will waive refill limits on 30-day maintenance drugs.