Many health insurers in Texas are waiving patient costs associated with COVID-19.
On March 10, Gov. Greg Abbott and the Texas Department of Insurance (TDI) asked insurers and HMOs to cover testing consistent with Centers for Disease Control and Prevention (CDC) guidance, and telemedicine visits. TDI also asked insurers to:
- Cover necessary medical equipment, supplies, and services;
- Waive penalties, restrictions, and claims denials for necessary out-of-network services;
- Waive requirements for preauthorization, referrals, notification of hospital admission, or medical necessity reviews for care consistent with CDC guidance;
- Allow extra time for physicians and facilities to file claims; and
- Authorize payment to pharmacies for up to a 90-day supply of any prescription medication for individuals, regardless of when the prescription was filled.
The governor has asked the Employees Retirement System of Texas, the Teacher Retirement System of Texas, the Texas A&M University System, and The University of Texas System to provide these same benefits to employees and retirees covered by their PPO and HMO plans.
Health Plans in Texas
While meeting the governor’s and TDI’s requests is voluntary, these payers have announced the following policies related to COVID-19:
Aetna will waive co-pays and apply no cost sharing for all diagnostic COVID-19-related testing at any authorized location for all commercial, Medicare, and Medicaid plans, and for self-insured plans. This policy will cover the test kit, and the physician visit that results in a COVID-19 test, for patients who meet CDC guidelines for testing. Aetna commercial plans also offer zero-pay video telemedicine visits for any reason through June 4, 2020, through the CVS MinuteClinic app, Aetna-covered Teledoc offerings, and visits with in-network physicians. (Self-insured plan sponsors will be able to opt out of either of these cost-waiving policies at their discretion.) Aetna also has extended its Medicare Advantage virtual evaluation and monitoring visit benefit to all fully insured members. CVS Health has several programs to help people deal with anxiety and stress related to COVID-19.
Also, Aetna will transition its provider portal from NaviNet to Availity on April 30. You can register for the new portal now. After April 30, you’ll lose your access to Aetna on NaviNet, including electronic transactions for Aetna and Aetna-specific tools. If you submit electronic claims or get electronic remittance advice from NaviNet, start downloading your activity, before you lose access.
Blue Cross and Blue Shield of Texas will waive copays and deductibles for testing to diagnose COVID-19 consistent with CDC guidelines, and will not require preauthorization. BCBS will cover telemedicine/telehealth visits as a regular office visit for physicians and providers who offer the service through two-way live interactive telephone or digital video consultations.
Cigna is waiving patient out-of-pocket costs through May 31 for COVID-19 visits with in-network physicians and other health care professionals, whether at a doctor’s office, urgent care center, emergency department, or via virtual care. Cigna waives out-of-pocket costs for COVID-19 FDA-approved testing. Only a physician, health care provider, or hospital can administer the test and send the sample to an approved lab for results. These policies apply to its fully insured members, including those in employer-sponsored, Medicare Advantage, and Medicaid plans, and plans available through the Affordable Care Act. Additionally, organizations that offer administrative services-only plans can opt to offer coronavirus testing as a preventive benefit.
Humana fully covers COVID-19 testing for patients who meet CDC guidelines, with no out-of-pocket costs at approved labs. This applies to Humana’s Medicare Advantage, Medicaid, and commercial employer-sponsored plans. Regarding telemedicine, Humana indicates it will follow Centers for Medicare & Medicaid (CMS) rules. It will waive members’ out-of-pocket costs for live video, urgent care telemedicine visits for the “next 90 days” (the website announcement was dated March 10) for in-network physicians. For physicians or patients without access to secure video systems, Humana will temporarily accept telephone (audio-only) visits; these visits can be billed as telehealth visits. Telehealth services must be medically necessary. Also, for the next 30 days, Humana is allowing early prescription refills for a 30- or 90-day supply as appropriate. Members can call the number on the back of their ID card to be connected to a coronavirus support line.
Molina Healthcare is waiving all member costs associated with coronavirus testing. Any related visit to a primary care doctor, urgent care, or emergent care does not require prior authorization.
Oscar will waive cost-sharing for physician-recommended diagnostic testing for COVID-19. Most plans also already provide zero-pay telemedicine services. In addition, Oscar has created a resource center.
UnitedHealthcare has waived all copays, coinsurance, and deductibles for COVID-19 diagnostic testing during the national emergency provided at approved locations in accordance with CDC guidelines for all commercial insured, Medicaid, and Medicare members. In addition, it is waiving cost-sharing for COVID-19 testing-related visits during this same time, whether at a physician’s office, an urgent care center, an emergency department, or through a telehealth visit. Care or treatment for COVID-19 will be covered in accordance with the member’s health benefits plan. Member deductibles, copays, and coinsurance will apply. UnitedHealthcare is also supporting self-insured plans that choose to adopt a similar policy. Note that UnitedHealthcare pays for telehealth services provided only through live, interactive audio and visual transmission to existing patients whose medical benefit plans cover telehealth services, unless otherwise permitted by state law (see UHC’s: Provider Telehealth Policies).
According to the governor’s office, these health plans also have begun to waive cost-sharing for medically necessary testing of COVID-19:
- Community Health Choice Inc.;
- Golden Rule Insurance (a short-term plan offered by UnitedHealthcare);
- Scott & White Health Plan; and
- Superior Health Plan (Centene).
Medicare Part B routinely covers medically necessary clinical diagnostic laboratory tests not subject to coinsurance or deductible and will cover any physician-ordered COVID-19 test received on or after Feb. 4.
The Centers for Medicare & Medicaid Services has created two new Healthcare Common Procedure Coding System (HCPCS) codes for labs for testing patients for coronavirus.
- HCPCS code U0001 is used specifically for CDC testing laboratories to test patients for the coronavirus.
- HCPCS code U0002 allows laboratories to bill for non-CDC laboratory tests for the virus.
The Medicare system will be able to accept claims with these codes on April 1, 2020, for dates of service on or after Feb. 4, 2020. Other health insurers also may choose to adopt HCPCS code U0002.
Medicare patients who would have been otherwise discharged from the hospital after an inpatient stay but are instead remaining in the hospital under quarantine would not have to pay an additional deductible for quarantine in a hospital. Hospitals having both private and semi-private rooms may not charge the patient more for a private room if the private room is medically necessary.
Medicaid and the Children’s Health Insurance Program will test recipients concerned about coronavirus at no cost when testing is ordered by a physician, according to the governor’s news release. Laboratory services are a mandatory benefit in Medicaid.