03/21/2020
Call your doctor first! Before you go in for testing… telemedicine is covered 100%.
Many of you are wondering how your health insurance will cover testing and treatment for COVID-19. There has been a lot of information released recently announcing that testing for COVID-19 will be covered 100%, but before you go, there are some details you need to know.
Insurers will cover COVID-19 testing when medically necessary and consistent with Centers for Disease Control guidance. So, how do I know if my provider will think it is medically necessary to test me? You should call your clinician for free and ask if you should come in for testing! Most if not all clinicians have added telemedicine services. Telemedicine is covered at no cost to you for visits for COVID-19 coverage along with visits for other medical concerns until April 30, 20. Ideally, you should call your Primary Care Provider, if you don’t have one, you can call any provider that is In-Network with your Insurance Carrier, and your insurance will pay for it. In addition, virtual visits are available online. Carrier specific info will be offered in a later post.
So, if you decide to go to the doctor/ Urgent Care / ER, and a test is not ordered and/or administered, your visit will not be covered 100%, but consistent with the terms of your medical plan.
We do not want cost to deter you from getting testing, if you are experiencing severe symptoms, should seek care immediately. Insurance will cover testing and treatment accordingly to the terms of your benefits. If you do not have severe symptoms, please keep in mind that there are individuals still need to receive care for injuries and illness not related to COVID-19. So, please do your best to save the resources for those who really need them.
Most importantly, please be patient and respectful to our healthcare workers, they are doing their best in a near impossible situation.
There are a limited number of tests available to Clinicians, and they are left to use their judgment along with the CDC guidelines to prioritizing testing for those who have severe symptoms or are at higher risk for poor outcomes. When additional testing capacity becomes available, it will allow clinicians to consider COVID-19 testing for a wider group of symptomatic patients.
Details regarding coverage: In response to the growing COVID-19/Coronavirus pandemic, Congress recently passed the Families First Coronavirus Response Act (the “Act”). The Act requires health insurers in the group and individual market to cover COVID-19.
Insurers shall not impose any cost-sharing (including deductibles, copayments, and coinsurance) requirements or prior-authorization requirements for the following items and services furnished during the emergency period defined:
COVID-19 Testing - Testing and Services coverage 100%
1) In vitro diagnostic tests (“COVID-19 Test”) for the detection or the diagnosis of the virus that causes COVID–19 that are approved by the FDA, and the administration of such in vitro diagnostics.
2) Items and services furnished to an individual during health care provider office visits, urgent care center visits, and emergency room visits that result in an order for or administration of a COVID-19 Test.
COVID-19 Treatment - With regard to treatment for COVID-19, plans cover medically necessary health benefits, including physician services, hospitalization and emergency services consistent with the terms of the member’s benefit plan.
The Oklahoma Insurance Department released a bulletin on Tuesday requesting health insurers take the following immediate measures related to the potential impact of COVID-19 on Oklahoma Consumers.
• Waive all cost-sharing for COVID-19 testing including
office visit or urgent care center cost-sharing.
• Waive all copays for telehealth services and reimburse
the providers for the copay.
• Cannot cancel coverage for anyone diagnosed with
COVID-19 for the next 90 days.
• Extend the normal 30-day grace period for non-payment
of premiums to 60 days.
• Requirement for a receipt signature for prescription
drugs is waived so that pharmacists can focus on
healthcare.
• Immediately cease all PBM audits of pharmacies.
• 60-day supply may be filled for a 30-day prescription
(excluding controlled substances).
• All restrictions on pharmacies doing mail orders are
waived.
Members should always call the number on their ID card for answers to their specific benefit questions.
IBGOK and its subsidiaries do not provide medical, legal or tax advice. Content is for general informational purposes and is not guaranteed to be accurate or complete. You should always consult a licensed medical clinician, attorney or tax professional regarding your specific circumstances.
