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Insurance firms: COVID-19 testing covered, treatment remains in question

A Matter of Time

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When it comes to health care billing concerns by those being tested for COVID-19, local insurance representatives’ message is simple: You’re covered.

As of March 26, officials reported 502 cases of COVID-19 in Missouri, including 25 in Greene County. According to data from the COVID Tracking Project, as of March 25, Missouri had conducted 725 tests.

“All carriers, including us, are covering lab testing, diagnostic testing,” said Cox HealthPlans President Matt Aug, noting it’s a benefit that bypasses a deductible and is paid by individual and group insurance plans without costs. “The insurance would not have any out-of-pocket expense at all.”

President Donald Trump’s administration indicated earlier this month testing is covered on a national level, regardless of whether the patient has insurance.

Vice President Mike Pence said at a March 12 meeting with leaders from private health insurance companies that patients won’t receive surprise bills after being tested for COVID-19. Additionally, the companies, which included Blue Cross Blue Shield, Aetna (NYSE: AET) and UnitedHealth Group Inc. (NYSE: UNH), agreed to waive copayments for people covered by their plans.

Treatment for the virus doesn’t appear to be as straightforward.

While Trump stated in a March 11 national address that insurers pledged to eliminate copays for coronavirus treatments and insurance coverage would be extended for them, Aug said he didn’t see it that way. Treatment would be covered under an insurance plan’s normal benefit, he said.

“We would cover it as part of the benefit plan, but their normal out-of-pocket would still apply at this point,” he said. “We haven’t seen anything come down that says all out-of-pocket is waived.”

CoxHealth President and CEO Steve Edwards said Trump sometimes makes bold statements without understanding how they’re mechanized. In reference to Trump’s March 11 prime-time speech, he said the president likely meant to say testing, not treatment, was free.

“At this point, even the insurance companies don’t know exactly what he’s talking about,” Edwards said.

Trevor Croley, president of Croley Insurance and Financial Inc., said to his understanding, COVID-19 treatment and medication is included as part of a general health policy.

“At this point, I haven’t heard of anybody who is treating this any differently from what the policy would normally be,” Croley said. “That’s a good thing because people need to be reassured that if something does happen, their health policy will cover that.”

However, Andrea Croley, managing partner at the Springfield agency, advised consumers to double check their policies with their insurance carriers. She said all of her agency’s group and individual plans through the Missouri Department of Commerce and Insurance will cover coronavirus-related health care.

CoxHealth had treated 15 COVID-19 patients, as of March 26, according to spokeswoman Kaitlyn McConnell. With 19 confirmed cases in the community, he’s concerned about the growth rate.

“What we’re worried about is that number won’t grow numerically, it’ll grow exponentially if we don’t suppress this,” he said.

Online evaluations with CoxHealth for COVID-19 are free with no billing, regardless of insurance, Edwards said.

“We know the insurance companies aren’t ready to process some of this,” he said, adding telemedicine is saving risk.

For patients that are hospitalized, Edwards said it’s going to be normal insurance and out-of-pocket expenses.

Federal guidance
Although the federal message on the reach of insurance coverage for COVID-19 has been unclear, help for workers impacted by the virus is on the way.

Trump on March 18 signed the $100 billion Families First Coronavirus Response Act, which includes several provisions to protect workers and help provide two weeks of paid sick leave for those impacted by COVID-19. It applies to all employers with fewer than 500 employees. A refundable payroll tax credit to employers covers 100% of the cost of wages, according to the act.

Federal lawmakers also crafted a bill that seeks to assist the U.S. workforce, as well as small businesses. The $2 trillion Coronavirus Aid, Relief and Economic Security Act includes $250 billion in direct payments to U.S. taxpayers and $350 billion for small-business loans that don’t have to be repaid, provided the businesses maintain their payrolls during the crisis. The bill also gives $150 million for the health care system, including funding for hospitals, research and treatment.

The Senate unanimously approved the bill, 96-0, with the House set to take up the measure March 27. President Donald Trump has indicated he would sign the bill.

Andrea Croley said her insurance agency has been working to address lingering questions for local employers. Many are asking about staff layoffs and enrollment in the Consolidated Omnibus Budget Reconciliation Act, a program that extends a current health insurance plan for up to 18 months following a job loss.

“We don’t have those answers yet,” she said, noting insurance and brokers are waiting for guidance from the federal government that should be more clear after all the emergency bills are active.

“These are all related to the pandemic part of this, the knee-jerk reaction and scare that we’re all getting ready to face the financial side of it,” Trevor Croley said of employer concerns he’s been hearing. “It doesn’t pertain to the virus itself.”

Aug said more guidance on the state level could come from the Department of Commerce and Insurance, if the agency determines there’s a need to diverge from what providers allow in health plans. Most carriers are supporting telehealth, early fills of prescriptions, promotion of mail ordering and the Retail 90 pharmacy network, which provides 90 days supply of prescription medications, he said.

“We’ll look at expanding benefit changes as it progresses,” he said. “We’re monitoring it daily. Clearly, if a vaccine comes out, we would cover that as well.”

Mental help
Mental health coverage related to COVID-19 also is front of mind for industry leaders, such as Burrell Behavioral Health’s C.J. Davis. The company president and CEO recently told Springfield Business Journal he’s hopeful if someone accesses care for anxiety surrounding COVID-19, they would have the ability to have those services covered.

Aug and the Croleys said mental health is covered in all employer health plans to some extent, including telehealth services.

“We would cover that, whether it’s related to COVID-19 or anything like social distancing, quarantine or anything like that,” Aug said.

Trevor Croley said it’s going to take time to sift through all the health insurance-related issues, as the pandemic has escalated rapidly.

“I’ve never been involved in anything so widespread, so fast, that changed our industry and brought up so many questions and concerns,” he said.

Features Editor Christine Temple contributed.

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