As devastating climate events increase in intensity and frequency, so has the sophistication of health insurers' disaster preparedness strategies.
Both not-for-profit and commercial insurers have lifted prior authorization requirements, relaxed pharmacy refill restrictions and eased payments collections in reaction to Hurricane Ida, which struck southern Louisiana on Sunday. Some private payers are likely following the Centers for Medicare and Medicaid Services's lead. The federal government considers Ida, which has been weakened to a tropical storm, to be a public health emergency and loosened gatekeeping requirements for Medicare enrollees, said Brad Ellis, senior director of insurance at Fitch Ratings.
Private insurers may be more financially motivated than the government.
"Getting people the care they need quickly, before it actually gets to an elevated level, can quite honestly help reduce overall costs," Ellis said. "It's the whole idea of diagnosing a disease before it reaches a higher level and therefore costs more too, that could be taking place, even in an emergency."
Payers' systemic approach to member care during Ida is simply the latest example that insurers see climate change as a social determinant of health, said Matt Wolf, director and healthcare senior analyst at RSM.
"Insurers are talking about it, they're thinking about it, they're strategizing about it, if for no other reason than it creates uncertainty in their business model. It creates uncertainty with their patients, and the whole business of insurance is to mitigate uncertainty," Wolf said.
In response to Ida, Blue Cross and Blue Shield of Louisiana, for example, is offering free telemedicine services to any member affected by Hurricane Ida and will replace medical devices damaged during the storm. Additionally, the not-for-profit insurer will offer members a premium grace period through Oct. 1, and has pledged $5 million to hurricane relief. Blue Cross and Blue Shield of Louisiana is still analyzing the financial impact the storm will have on its operations, the Baton Rouge-based insurer said.
AmeriHealth Caritas Louisiana, which operates a Medicaid managed-care plan under Healthy Louisiana, is working with the Louisiana Department of Health to supply its more than 226,000 members with medical supplies and emergency equipment. Half of its customers live in areas impacted by Ida, the Baton Rouge-based company said.
Among for-profit payers, UnitedHealth Group, Humana and Aetna have all lifted prior authorization and referral requirements and allow early prescription refills. Cigna likewise will cover all urgent care and emergency services at in-network rates, removed prescription drug refill restrictions and will offer customers extra time to settle bills. Both UnitedHealth and Cigna set up 24/7 emotional support lines.
"Waiving requirements around authorization and copayments, that's not just a burden for patients," said Scott Posecai, executive vice president of insurance partnerships and treasurer at New Orleans-based Ochsner Health. "We have to collect, and the last thing we want to do is press patients in these types of circumstances."
These actions by insurance companies have helped not-for-profit Oschner Health, which regained power at its main campus Thursday, deal with the crisis. But the company is still awaiting guidance about how to navigate billing and collections for patients who were transferred to non-approved settings, such as skilled nursing facilities instead of outpatient sites, Posecai said. Some insurers, but not all, have relaxed their policies, he said.
"Going through hoops with payers to get approvals for the right level of post-acute service versus inpatient rehab are things that we just don't have the time to battle right now," Posecai said. "Every day that those things hang out there keeps our hospitals full, and we're not able to take on the patients who have injuries from the storm or acute illnesses."
Local plans including Blue Cross and Blue Shield of Louisiana have been quicker to implement policies than national plans, which Posecai credited to local insurers' experience dealing with previous regional natural disasters, such as Hurricane Katrina in 2005. Katrina probably led to a short-term financial windfall for insurers because they processed fewer claims, he said. But insurers suffered over a longer term as many Louisiana residents moved away from the area and stopped being customers, he said.
Likewise, the climate crisis will led to higher health insurance premiums over time, Wolf said.