How Health Insurance Providers Are Responding to Covid-19
The novel coronavirus, COVID-19, presents an unprecedented challenge to our state and the health of its citizens. North Carolina’s health insurance providers are working hard to make certain that our 6 million members get the care they need. We are also implementing measures to ease financial and administrative burdens for the doctors, nurses and other health care providers on the front line of the pandemic. From waiving co-pays and deductibles for COVID-19 treatment to easing prior authorization requirements, to expanding access to telehealth, health insurers are doing their part to help.
Response to COVID-19
- Waiver of cost sharing (co-pays and deductibles) for COVID-19 testing and treatment
- Waiver of prior-authorization requirements
- Expanded coverage for telehealth
- Coverage of treatment for anxiety and depression
- Protecting patients from surprise medical bills
- Ensuring access to medications
Waiver of Member Cost-Sharing and Network Restrictions
Cost should not be a barrier to seeking testing and care for COVID-19. Health plans are waiving member cost-sharing such as co-pays and deductibles for COVID-19 related treatments both in-network and out-of-network. In addition, most health plans will fully reimburse out-of-network providers for COVID-19 care at in-network or Medicare rates as appropriate. The member cost-share waiver of COVID-19 related treatments applies to fully insured, State Health Plan, and Medicare members. Self-funded employer groups have the option to apply these changes to their employees’ plans. As the pandemic stretches health provider resources, these measures will give members additional options to seek care and ease financial burdens on patients and physicians.
Waiver of Prior-Authorization Requirements
Fighting this virus requires that patients receive testing and appropriate treatment quickly. Health plans have waived prior authorization requirements for COVID-19 screening, testing, and treatment. This will ensure that patients have speedy access to care and reduce the administrative workload for health providers fighting the pandemic.
Supporting Health Care Providers
We recognize the tremendous pressure COVID-19 is placing on our healthcare providers and are committed to supporting the hospitals, physicians, and nurses on the front lines of responding to this pandemic. Health plans are working to address potential short-term cash flow challenges providers may face as a result of the crisis by speeding claims payments. Some plans have also launched web sites, hosted educational webcasts and offered individual assistance to help providers obtain loans and grants. In addition, insurers have temporarily relaxed many requirements, such as prior authorization, to reduce the administrative workload of health providers as they face a surge in new patients. Finally, many health insurance companies are bolstering the health care workforce by offering paid leave to medical personnel who volunteer to help with COVID-19 care.
Protecting Patients from Surprise Medical Bills
Health plans are working to protect members from unexpected medical bills, especially when they seek care out-of-network. While we recognize that North Carolina law permits providers to bill members directly, we are committed to working with providers to prevent surprise medical bills. Plans are offering out-of-network providers in-network or Medicaid rates, as appropriate, and urging providers to accept full payment from the insurer without seeking additional payment from patients.
Coverage of Mental Health Services
We believe it is important to care for the health of the whole person – including both physical and behavioral health. Health plans recognize the impact the pandemic is having on behavioral health and are focusing their efforts not just on physical health, but on behavioral health as well.
Expanded Coverage for Telehealth
Allowing patients to receive care without leaving their homes reduces the risk of spreading the virus and eases the strain this pandemic is placing on emergency rooms, hospitals, and doctors’ offices. Many health plans have eliminated co-pays and expanded coverage for virtual doctor visits. During the crisis, plans will also reimburse providers for telehealth services at the same rate as in-person visits. Finally, health plans are coordinating with the North Carolina Department of Health and Human Services to streamline telehealth policies and simplify the process of delivering health care services virtually.
Ensuring Access to Medications
It is vitally important that our members have continued access to the medications they need, especially during this crisis. Health plans have taken steps such as waiving early medication refill limits, allowing members to request a 90-day prescription of maintenance medications from their doctor, and offering maintenance medications by mail order. These steps will help ensure that patients are able to maintain adequate supplies of vital medications.
Supporting Community Response to the Crisis
Health insurance providers are working closely with community organizations and government agencies providing people with services and basic necessities to stay healthy. Plans are making donations to support food pantries, distributing gift cards through local providers and other organizations to help people maintain access to essential supplies, and working to secure personal protective equipment like gowns and masks for physicians.