The Division of Insurance issued on Friday a bulletin signed by Commissioner, Gary A. Anderson, to all health insurers advising them to waive any deductibles, co-pays and similar payments under their health insurance involved with any potential treatment or diagnosis of the Coronavirus.
The commissioner addressed Bulletin 2020-02 to all “Commercial Health Insurers, Blue Cross and Blue Shield of Massachusetts, and Health Maintenance Organizations” (“Health Insurers”) to advise them of “the Division’s expectations regarding carriers’ appropriate coverage of testing and treatment for COVID-19, also known as Coronavirus, and other actions that will directly address the potential impacts of Coronavirus.”
The Division expects Health Insurers to “take all appropriate steps to safeguard the general public and well-being of the Commonwealth’s citizens”
Because of the critical role health insurance coverage plays a critical role in the public’s actual and perceived access to and affordability of health care services. Coronavirus may impose unique risks to our insurance market that Massachusetts has not faced for at least a generation. Therefore, the Division is notifying Massachusetts Carriers that it expects them to take all necessary steps to enable their covered members to obtain medically necessary and appropriate testing and treatment that will help fight the spread of this disease.
The Division also expects health insurers to waive copayments, deductibles, and coinsurance for in-network and out-of-network Coronavirus related services
The Division initially expects health insurers to forego any cost-sharing (copayments, deductibles, or coinsurance) for medically necessary:
- Coronavirus testing:
- Coronavirus counseling and vaccinations [presumably if a vaccine becomes available] at in-network doctors’ offices, urgent care centers, or emergency rooms; and,
- Counseling and vaccinations at out-of-network doctors’ offices, urgent care centers, or emergency rooms when access to urgent testing or treatment, in accordance with DPH (Department of Public Health) and CDC (Center for Disease Control) requirements, is unavailable from in-network providers.
Also, the Division wants the Health Insurers to promote telehealth options to reduce the need for insureds evidencing Coronavirus to seek screening, evaluation, diagnosis and/or treatment for the virus without the need to come to medical facilities where they might spread the Coronavirus, if infected, or come into contact, if they are not infected, with Coronavirus infected patients.
The bulletin does not seem to address any copayments, deductibles, or coinsurance for those insureds who may need in-patient care.
Health Insurers should also set up dedicated Coronavirus helplines and promote telehealth services for suspected Coronavirus infections
The Bulletin also states that the Division expects all Health Insurers to:
- Establish dedicated helplines to respond to all calls about the Coronavirus and keep covered members aware of providers who test/treat the virus, members’ available benefits, and phone numbers that members can call for additional help.
- Relax prior approval requirements and procedures so that members can get timely medically necessary testing or treatment, in accordance with DPH and CDC guidelines, if they are at risk of contracting the Coronavirus.
- Relax out-of-network requirements and procedures when access to urgent testing or treatment, in accordance with DPH and CDC requirements, is unavailable from in-network providers.
Blue Cross responds immediately in implementing Bulletin 2020-20 along with the Massachusetts Association of Health Plans
The commissioner issued his bulletin on March 6. The Blue Cross-Blue Shield “Massachusetts Statement on Coronavirus (COVID-19)” now advises that effective March 6, Blue Cross will:
- Cover the full cost of diagnostic tests for COVID-19 for its fully insured account members.
- Cover the cost of vaccination when a COVID-19 vaccine is available and waive co-payments for medically necessary COVID-19 treatment at doctor’s offices, emergency rooms, and urgent care centers.
- Waive prior authorizations and referrals, for members receiving medically appropriate care for COVID-19: and,
- Consistent with the CDC recommendations, allow early refills of 30-day prescription maintenance medication to allow insureds to have a one-month supply of their medications on hand.
The Blue Cross-Blue Shield Coronavirus page is available by clicking here.
The Massachusetts Associations of Health Plans also advises on its website that the member health plans of the association are also implementing the steps specified on the commissioner’s Bulletin 2020-20. The Association’s “Covid-19 (Coronavirus) QUESTIONS & ANSWERS March 9, 2020” lists on page 2 that the association’s member plans will specifically:
- Establish dedicated helplines to respond to member calls about Coronavirus.
- Promote telehealth options to enable members to seek screening, evaluation, diagnosis and/or treatment for Coronavirus in order to reduce the need for patients to come to medical offices where they may come into contact with the Coronavirus.
- Relax prior approval requirements and procedures so that members can get medically necessary testing or treatment in accordance with DPH and CDC guidelines if they are at risk of contracting Coronavirus.
- Relax out-of-network requirements and procedures when access to urgent testing or treatment in accordance with DPH and CDC guidelines is unavailable from in-network providers.
- Forego any cost-sharing (copayments, deductibles, or coinsurance) for medically necessary Coronavirus testing, counseling, and vaccinations at in-network doctors’ offices, urgent care centers, or emergency rooms; and at out-of-network doctors’ offices, urgent care centers, or emergency rooms when access to urgent testing or treatment in accordance with DPH and CDC requirements is unavailable from in-network providers: and,
- Forego any copayments for medically necessary Coronavirus treatment, in accordance with DPH and CDC guidelines, at in-network doctors’ offices, urgent care centers, or emergency rooms; and at out-of-network doctors’ offices, urgent care centers, or emergency rooms when in-network alternatives are not available.
For the association’s coronavirus page click here.
The full text of Bulletin 2020-20
The full text of “Bulletin 2020-02; Addressing COVID-19 (Coronavirus) Testing and Treatment; Issued 3/6/2020” is available by clicking here.
