Insurers are voluntarily covering the diagnostic testing of the coronavirus, according to the Board of Directors for America’s Health Insurance Plans.
Health insurers will cover needed testing when ordered by a physician. They are taking action to ease network referral and prior authorization requirements, and/or waiving patient cost-sharing, AHIP said.
AHIP said it is also working with public and private-sector partners so that out-of-pocket costs are not a barrier to people seeking testing and treatment for COVID-19.
The trade association is also working with state and federal policymakers to provide more guidance and flexibility for preventive services, benefit design and treatment options.
In a separate statement, Cigna said its customers will have access to coronavirus testing, as prescribed by health practitioners, and the company will waive all co-pays or cost-shares to help fight the rapid spread of the virus. Cigna will cover the medical test similar to a preventive benefit for fully-insured plans, thereby waiving co-pays, coinsurance or deductibles for customers.
CVS Health also said it is providing COVID-19 diagnostic testing with no out-of-pocket costs or cost sharing for Aetna members. Also, Aetna members will have access to telemedicine visits with no out-of-pocket costs or cost sharing,
Current testing is available through the Centers for Disease Control and Prevention and is being offered at no cost. Testing is expected to expand shortly as more commercial testing becomes available at a designated lab approved by the U.S. Food & Drug Administration.
The U.S. government is being criticized for not having enough CDC testing kits available.
WHY THIS MATTERS
President Trump today signed an $8.3 billion coronavirus funding package.
Funding, insurer and policy efforts are aimed at stopping the spread of the virus.
One way this is being done is through a provision in the spending package to waive telehealth restrictions for Medicare beneficiaries.
AHIP said it is encouraging the use of telehealth, at-home care and other technology-enabled options to expand access to care while avoiding the potential risk of infection.
So that labs and providers get reimbursed for testing, the Centers for Medicare and Medicaid Services has developed a second Healthcare Common Procedure Coding System code that can be used to bill for certain COVID-19 diagnostic tests. The second HCPCS billing code (U0002) allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV.
Last month, CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus. This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2.
On February 29, 2020, the Food and Drug Administration issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers.
The Medicare claims-processing systems will be able to accept these codes starting on April 1 for dates of service on or after February 4.
THE LARGER TREND
The coronavirus has infected over 100,000 worldwide and an estimated 233 people in the U.S.
ON THE RECORD
“We are sharing information with clinicians, mobilizing our network providers, and coordinating through care management programs to ensure that they have the best, most immediate data to identify, diagnose, and treat infections,” the AHIP Board of Directors said.
“During this time of heightened concern, Cigna’s role is clear. We will do everything we can to help contain this virus, remove barriers to testing and treatment, especially for seniors and people who are chronically ill, and give peace of mind to those we serve,” said David M. Cordani, president and CEO of Cigna.
The ATA is an organization working to accelerate the adoption of telehealth.
“Many ATA members are providing solutions that are helping to keep people safe and out of hospitals and doctors’ offices, map the virus and triage individuals needing medical care,” said Ann Mond Johnson, CEO of the ATA. “Telehealth is well-suited to provide one-to-many care that is safe, effective and efficient. We are seeing the significant value telehealth offers, not only in public health emergencies, but also in day-to-day care delivery.”
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