The coronavirus epidemic has obviously made all our lives more complicated. Unfortunately, this headache-inducing complexity extends to our health insurance as well. Millions of Americans do not know what kind of coverage they have for coronavirus testing, how much they should have to pay for that testing, or whether there are any hidden “gotchas” that insurers might use to deny their claims or reduce payment for testing.
Fortunately, the California Department of Insurance (CDI) recently issued a COVID-19 Testing and Coverage Frequently Asked Questions (FAQ) notice which helps answer some of these questions. (Much of the information is derived from federal law, so even if you don’t live in California, this FAQ may still help you.)
The FAQ addresses numerous issues, but the most important takeaways are:
- Insurers are required to waive cost sharing for COVID-19-related screening and testing. This is mandated not only by the CDI’s March 5, 2020 Screening and Testing Bulletin, but also by subsequently enacted federal law. As usual, there are some exceptions, but for the most part, consumers should not be bearing the financial burden of screening and testing.
- Insurers cannot impose this financial burden on health care providers, either. This means that when insurers compensate providers for COVID-19 screening and testing, they cannot deduct the cost-sharing from that payment. Furthermore, federal law requires insurers to reimburse providers at the in-network negotiated rate.
- Federal law requires insurers to cover COVID-19 diagnostic testing regardless of whether the provider is in the insurer’s network.
- Insurers are required to pay claims within 30 working days after receipt.
- If you received authorization from your insurer for a procedure, but the procedure was canceled due to coronavirus “stay at home” orders, you may need to get another authorization. While the CDI encourages insurers to extend the expiration dates of authorizations, there is no legal requirement for them to do so. As a result, you should consult with your provider and insurer to make any necessary arrangements.
Obviously, this CDI FAQ does not answer all the questions you might have about COVID-19 insurance coverage. We encourage you to visit the CDI’s COVID-19 resource page for more information. This page answers many questions about what coverage you might have, coverage you might be able to obtain, and how you might be able to get assistance from other governmental agencies.
If you or someone you know are being denied coverage or benefits by your insurer, please call Kantor & Kantor for a free consultation at 888-569-6013 or use our online contact form. We understand, and we can help.