As the number of coronavirus cases continues to climb, states and health insurers are taking steps to ensure Americans can afford testing and treatment needed to prevent a widespread COVID-19 outbreak.
Taking cues from New York, Washington state's insurance commissioner issued an emergency order on Thursday directing state-regulated health insurers to waive any copayments or deductibles for patients who need tests for the coronavirus.
The order further requires insurance companies to allow a one-time early refill for prescription drugs and to suspend any prior authorization requirements for coronavirus-related testing or treatment.
"Consumers are rightly concerned about prevention, testing and possible treatment," Washington Insurance Commissioner Mike Kreidler said in a statement. "My emergency order provides guidance to health insurers and should help reassure the public that we will take all necessary steps to protect them."
The requirements apply to individual, small group and fully insured large employer plans, as well as short-term limited duration insurance plans, until May 4. It does not apply to self-funded employer plans, which is where many Americans get their health coverage.
Washington state has been most affected by the coronavirus, with 70 confirmed cases and 10 deaths, according to the state health department. Its emergency order follows the blueprint laid out by New York Gov. Andrew Cuomo, who on Monday ordered insurers to waive cost-sharing for all medical expenses related to the coronavirus testing, including emergency department care and visits to in-network urgent care centers and physicians' offices.
So far, 212 cases of the coronavirus have been identified in the United States, according to a database created by Johns Hopkins University. The virus, which originated in Wuhan, China, has rapidly spread to more than 80 countries with global cases nearing 100,000 in just a couple of months.
Patients' ability to afford doctors' visits and testing related to the coronavirus may be an obstacle to preventing a major outbreak in the United States. Public health experts and lawmakers are worried that patients, particularly those who are uninsured, would be unable to afford a vaccine for the virus if one is developed.
More than 27 million Americans do not have health insurance, and they may be more likely than insured people to skip the doctor's office when sick to avoid medical bills. Millions more are underinsured, meaning they have high deductibles and out-of-pocket expenses that make them more likely to struggle with bills and put off care.
For now, the Centers for Disease Control and Prevention is covering the cost of coronavirus testing, but private labs will soon charge for their own tests.
"Insurers would set a lot of people's minds at ease if they committed to covering coronavirus testing with no patient cost-sharing," Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, said in an email. "Healthcare providers would still need to ensure that only people who are clinically advised to get tested do so to preserve limited testing resources. But, for the health of individuals and the community at large, cost shouldn't be a barrier to get tested."
In a statement published Thursday, the board of directors of America's Health Insurance Plans, the country's largest insurance trade association, said insurers "are taking decisive action to help prevent the spread of this disease" by ensuring that out-of-pocket healthcare costs are not a barrier to coronavirus testing and treatment.
AHIP's board, which includes the CEOs of some of the largest insurers, including Anthem, Cigna and Humana, committed to covering needed diagnostic testing and easing network, referral and prior authorization requirements or waiving cost-sharing for services related to the virus.
AHIP said it is also partnering with providers to ensure they have data needed to identify, diagnose and treat infections, while encouraging the use of telehealth and at-home care to prevent infection.
In a separate statement, Cigna said it will cover the test for the coronavirus as a preventive benefit, waiving all cost-sharing for fully insured employer-sponsored plans in the United States, Medicare Advantage, Medicaid and individual and family ACA plans. Large self-insured employers that contract with Cigna for administrative services will have the option to do the same for their employees, Cigna said.
The health insurer said it is standing up a round-the-clock resource center to help any members with administrative barriers related to coronavirus claims.
"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," Cigna CEO David Cordani said. "This is another example of how, every day, we strive to stand by our customers through their life and health journeys."
Other insurers are focused on encouraging members to seek care through a virtual visit, which is cheaper than an in-person doctor's visit and is covered by most commercial health plans and large employers. Telehealth has been slow to catch on among physicians and patients, however.
Calif.-based integrated health system and insurer Kaiser Permanente said it is using telehealth to conduct preliminary screening for coronavirus. It also said it supports a state-wide waiver of out-of-pocket costs for patients who seek screening or care related to the virus, regardless of the setting. Kaiser Permanente said it already waives copays for many phone and video visits.
Blue Cross and Blue Shield of North Carolina this week announced it is expanding access to virtual visits by paying for telehealth visits at the same rate as an in-person visit starting Friday. This will help minimize the spread of the virus and free up space in the ED, the insurer said. The Blues plan also said it would allow patients to re-fill maintenance medications early and would speed up approvals for needed care.
A spokeswoman for New York-based Oscar Health said the insurer focused on driving members to use telehealth if they think they've been exposed to the virus.
