As the COVID-19 event continues to evolve, health insurance providers have been updating policies to change with it. Here are important updates from the top 4 insurance providers in the Midwest that healthcare billers should be aware of:
Blue Cross Blue Shield
“Member cost share will be waived for fully insured commercial members, including members with an individual plan and Medicare (Advantage, Cost, Supplement) members for inpatient and outpatient evidence-based treatment of COVID-19 provided by an in-network provider or facility under the member’s specific benefit plan. The waiving of cost share is in effect for dates of service between 2/4/2020 and 9/30/2020 and will apply to facility claims with admission dates between 2/4/2020 and 9/30/2020. The cost share waiver excludes retail prescription drugs as there is no current FDA approved prescription treatment for COVID-19. On a professional claim, lines submitted without” a confirmed COVID-19 diagnosis will be assessed a member cost share, if applicable” (Blue Cross Blue Shield website).
“HealthPartners, will waive member cost-sharing for all fully insured commercial, Medicare and Medicaid members for in network COVID-19 related treatment through September 30, 2020. We are actively working with our self-insured clients to make this option available for their employees and dependents.
  • Waiving early medication refill limits on 30-day prescription authorizations and encouraging 90-day mail order benefits
  • Allowing retail pharmacists at point of sale to override claim that is rejecting for ‘refill too soon’
  • Removing prior authorization for COVID-19 diagnostic service
  • Coverage of medically necessary tests
  • Providing coverage for online care eligible to all HealthPartners members
  • Expanding access to telehealth” (HealthPartners website)
“To make sure access to care is easily available and in keeping with regulations, PreferredOne will now waive cost-sharing for in-network COVID-19 hospitalization for fully-insured, Simplicity employer and individual plan members effective March 1st through September 30th, 2020.
PreferredOne continues to waive cost sharing for CDC-recommended COVID-19 laboratory testing ordered by a provider and related telehealth, office, urgent care, and emergency department visits for all members.
At this time, PreferredOne will maintain our usual guidelines with regards to timely payment of premiums and / or grace periods.
For fully insured, PreferredOne will honor the normal grace periods. There is some talk at the state level of increasing the grace period to 90 days for fully insured. If that goes through then we will comply. Beyond the leeway with hours worked / furloughed status already communicated and honoring grace periods, PreferredOne isn’t in the position to provide relief on premium payments” (PreferredOne website).
Medica Health Plan
“Medica will waive your copays, co-insurance and deductibles for medically necessary in-network COVID-19 diagnostic testing. This applies to testing that meets guidelines from Centers for Disease Control and the Food and Drug Administration (FDA), and is ordered by an appropriate medical professional. These changes are retroactive to March 1, 2020, and will extend through July 31, 2020.
Medica will waive your copays, co-insurance and deductibles for Food and Drug Administration (FDA)-approved antibody tests after a suspected (not confirmed) COVID-19 diagnosis. Tests must be ordered by a medical professional and considered medically necessary.* Coverage for the antibody test applies both in-network and out-of-network, and will extend to office visits and other charges related to the antibody test when performed at in-network locations. This new coverage will extend through July 31, 2020.
*Not covered as part of a return to work request.
Medica will waive your copays, co-insurance and deductibles for in-network COVID-19 inpatient hospital care for fully insured group members. These changes are retroactive to March 1, 2020, and will extend through September 30, 2020” (Medica website).
Providers needs to make sure they’re up-to-date on any changes that occur through either coding or coverage during these complicated times. The experts at Outsource Receivables Inc. keep track of important updates like these and can help your billing get back on track.
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