COVID-19 Spurs Significant Policy Changes by Commercial Plans

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Commercial health plans have made numerous policy changes in response to the COVID-1 pandemic, some of which were done in response to mandates issued by state and federal governments, and others in response to pressures being put on providers that are grappling with the clinical and financial effects of the pandemic. Set forth below are a few of the most recent policy changes implemented by a selection of commercial health plans. Note that the plans are constantly updating their policies, and therefore changes will continue to occur. Many of the policy changes described below are state-specific, so care will need to be used to confirm that a change has been implemented in your state. Also note that employer-sponsored self-funded benefit plans that access a commercial plan’s contractsmight try to follow different policies than the commercial plan -- including with respect to prior authorization and waivers of copayments for testing and treatment for COVID-19. Therefore, some commercial plans are recommending that providers confirm that a self-funded benefit plans has implemented policies similar to those implemented by the host plan. Contracted providers also may have contract provisions with commercial plans affecting whether or not self-funded plan customers can have different policies.

Aetna

  • Aetna is waiving cost sharing for COVID-19 testing and treatment. Guidance.

  • Until June 4, 2020, Aetna will waive member cost sharing for any covered telemedicine visit – regardless of diagnosis. Guidance

  • Aetna is temporarily waiving initial precertification/prior authorization for inpatient services, post-acute care, and long term cute care admissions in many states. A full list of states where this temporary waiver is in place is available here.

Anthem

  • In many states, Anthem is waiving cost sharing for COVID-19 testing and treatment. Georgia Guidance. California Guidance.

  • In California, Anthem is expanding coverage for telehealth, applicable to “all types of services” when “medically appropriate.” California Guidance.

  • In Georgia, Anthem is providing coverage for telephonic-only services -- Anthem normally does not cover telephonic-only services (with limited state exceptions) -- for 90 days effective March 19, 2020. Georgia Guidance.

  • In Georgia, Anthem is suspending preauthorization for scheduled surgeries or admissions for 60 days, starting March 26. Georgia Guidance.

  • In many states, Anthem has delayed certain formulary changes, with certain exceptions, that were scheduled to go into effect on April 1, 2020. Georgia Guidance. California Guidance.

Blue Shield of California

  • Blue Shield of California is waiving cost sharing for COVID-19 treatment received between March 1 and May 31. Guidance.

  • When a capitated provider waives a cost share for COVID-19 screening and testing, Blue Shield of California will reimburse the capitated providers for the waived cost shares. Guidance.

Blue Cross Blue Shield of Illinois

  • Blue Cross Blue Shield of Illinois is waiving cost sharing for COVID-19 testing, but not for treatment. Guidance.

  • Blue Cross Blue Shield of Illinois will cover telehealth for all covered benefits, whether provided in-network or out-of-network. Guidance.

Cigna

  • Cigna will waive costs sharing related to COVID-19 screening, testing and treatment through May 31, 2020 Guidance.

  • Cigna will allow providers to bill a standard face-to-face visit for all virtual care services, including those not related to COVID-19. Guidance.

HCSC

  • HCSC will waive copays for COVID-19 testing. Guidance.

  • HCSC will waive cost sharing for COVID-19 treatment when provided at an in-network provider, or when provided to treat an emergency at an out-of-network provider. Guidance.

  • HCSC will waive cost sharing on covered telemedicine or telehealth services, when provided in-network. Guidance.

Health Net of California

  • Health Net is waiving cost sharing for medically-necessary COVID-19 testing and treatment. Guidance.

  • When a capitated provider waives a cost share for COVID-19 treatment, Health Net will reimburse the capitated providers for the waived cost shares. Details regarding the process for capitated services to receive reimbursement for waived member cost shares will be released at a later date. Guidance.

  • Health Net is not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services. Guidance.

  • Health Net is extending the deadline to file claims for providers impacted by COVID-19 to three months beyond standard filing timelines or the timeline in the Health Net Provider Participation Agreement (PPA). Guidance.

  • Health Net will cover telehealth services delivered March 17 through June 30, 2020 at zero member cost share. Guidance.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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