This is a review of the responses to the Coronavirus Covid-19 health care issues from the websites of most of the individual and family plan carriers in California. Some websites detail the response and cost of Covid-19 health care issues better than other. They all seem to be covering Covid-19 testing at no cost. The cost of other health care services are subject to the plan benefits.
No carrier has announced an extended grace period on the payment of premiums as of March 26, 2020.
California Department of Managed Health Care https://www.dmhc.ca.gov/
SUBJECT: APL 20-009 – Reimbursement for Telehealth Services
In response to the COVID-19 pandemic, it is imperative that people practice “social distancing.” However, people also need to be able to continue to have access to necessary medical care. Accordingly, health plans must take steps to allow people to obtain health care via telehealth1 when medically appropriate to do so.
Pursuant to the authority granted in the California Emergency Services Act (Gov. Code sections 8566, et seq.), all health plans shall, effective immediately, comply with the following:
1. Health plans shall reimburse providers at the same rate, whether a service is provided in-person or through telehealth, if the service is the same regardless of the modality of delivery, as determined by the provider’s description of the service on the claim. For example, if a health plan reimburses a mental health provider $100 for a 50-minute therapy session conducted in-person, the health plan shall reimburse the provider $100 for a 50-minute therapy session done via telehealth.
2. For services provided via telehealth, a health plan may not subject enrollees to cost-sharing greater than the same cost-sharing if the service were provided in-person.
3. Health plans shall provide the same amount of reimbursement for a service rendered via telephone as they would if the service is rendered via video provided the modality by which the service is rendered (telephone versus video) is medically appropriate for the enrollee.
Covered California “All medically necessary screening and testing for COVID-19 are free of charge, and all health plans available through Medi-Cal and Covered California offer telehealth options.”
Anthem Blue Cross
https://www.anthem.com/ca/coronavirus/
Anthem will cover the costs of COVID-19 screening and testing
All Anthem plans will cover medically necessary screening and testing for COVID-19 and will waive all cost shares (co-pays, coinsurance and deductibles). This includes screenings and/or tests that take place at in-person office visits, drive-through sites, virtual on-line visits and telephone calls. If a member is diagnosed as having COVID-19, their Anthem health plan benefits will apply to treatment of the virus.
Anthem is waiving member cost shares for in network telehealth services
As of March 17, 2020 and until further notice, Anthem and its care providers will waive cost sharing for members using Anthem’s telemedicine service, LiveHealth Online, as well as care received from other in-network providers delivering virtual care through internet video + audio services. Member cost shares for telehealth services will not be waived for out of network providers, except for COVID-19 screening. Self-insured plan sponsors have the choice to participate and may opt out of this program. Members enrolled in self-insured plans can call the Member Services number on the back of their ID card.
In addition to telehealth, Anthem will cover telephonic-only services
As of March 19, 2020, Anthem and its care providers will cover telephone-only medical and behavioral health services from in-network providers. Exceptions include chiropractic services, physical, occupational, and speech therapies. These services require face-to-face interaction and therefore are not appropriate for telephone-only consultations. Out-of-network providers will only be covered for plans with out-of-network benefits. Self-insured plan sponsors have the choice to participate and may opt out of this program. Members enrolled in self-insured plans can call the Member Services number on the back of their ID card.
Anthem is encouraging its members to use LiveHealth Online to virtually connect to a doctor through
a live video chat on their phone, tablet, or computer. The LiveHealth Online doctors can screen for COVID-19 and make
recommendations for care. Members can find more information on Live Health
Online here.
Members can also use Anthem’s Sydney
Care mobile app today for a quick and easy way to evaluate your symptoms
and see a doctor, again free of charge. Members can check their symptoms, and
then the app will connect them to a doctor through a LiveHealth
Online video session or a Virtual Care text session right from your phone.
Members can download the Sydney Care mobile app here.
Members can also call the Anthem 24/7 NurseLine at the number listed on their Anthem ID card to speak with a registered nurse about health questions.
Prescription Medications and Pharmacy Services
Anthem is relaxing early prescription refill limits, where permitted, for members who have Anthem pharmacy benefits and wish to refill a 30-day supply of most maintenance medications early. Additionally, members who have a pharmacy plan that includes a 90-day mail-order benefit should talk to their doctor about whether changing from a 30-day supply to a 90-day supply of their prescriptions is appropriate. There are no delivery charges for members who use Anthem’s Home Delivery Pharmacy. Members can call the Pharmacy Member Services number on their health plan ID card to learn more.
Blue Shield of California
https://www.blueshieldca.com/coronavirus/your-coverage
Does my plan cover COVID-19 testing?
Blue Shield of California will cover the costs of COVID-19 tests recommended by a doctor and waive out-of-pocket costs (copays, coinsurance, and deductibles) for:
- Doctor visits for screenings
- Emergency room (ER) or hospital visits for screenings
- Urgent care visits for screenings
Waived out-of-pocket costs apply to these plans only:
- Plans purchased directly from Blue Shield
- Plans purchased through Covered California
- Most employer-sponsored plans*
- Medicare plans
- Medi-Cal plans
If you’re not sure what type of plan you have, call the number on your member ID card.
There are no prior approvals needed for COVID-19 screening, testing, and treatment.
*Note: If your member ID card says “Administrative Services Only,” you may have different costs related to COVID-19 screening and testing. Please call the number on your member ID card if you have questions.
What virtual care options does my plan cover?
If you have a fever, cough, and feel short of breath, we suggest using a virtual care option such as Teladoc or NurseHelp 24/7SM before seeking in-person care. This will help reduce the risk of spreading the virus. Through May 31, Blue Shield is covering your costs for Teladoc visits. NurseHelp 24/7SM is always available at no additional cost.
- With Teladoc, you can talk to a doctor 24/7 by phone or video to screen for the virus. Learn how Teladoc can help.
- You can also talk to a registered nurse anytime with NurseHelp 24/7SM.
Not all plans have access to these services. Log in to your online account to see what benefits your plan covers.
You can also call your primary care physician (PCP) for advice. If your doctor or nurse recommends testing for COVID-19, they can tell you where to go to get tested.
Some plans also include Heal for on-demand house calls in select cities. Learn how Heal can help. If Heal is included in your plan, there is no copay for remote screenings. If you don’t have Heal in your plan, you can request a remote call for $19 cash price to screen for COVID-19. If the doctor comes to your home, different costs apply. See if Heal is available for you.
What if I need treatment for COVID-19?
If you test positive for COVID-19, your care will be covered, and your standard plan benefits will kick in. You will be responsible for any out-of-pocket costs related to your treatment. Log in to check your coverage or call the number on your Blue Shield member ID card.
What if I need to refill my prescriptions?
If you are worried you might run out of prescribed medications, Blue Shield allows early refills on your prescriptions. This is for all members with pharmacy benefits through Blue Shield. If you have specific questions about the medicine you take, call the Member Services number on your member ID card.
Consider ordering a 90-day supply through our mail service pharmacy, CVS Caremark. 90-day supply prescriptions are available for maintenance medications used to treat chronic conditions for most lines of business. Call your doctor to switch to a 90-day prescription.
Medicare members can also fill a prescription for a 90-day supply of maintenance medications at retail pharmacies in addition to our mail service pharmacy. Call your local pharmacy to ask about delivery or utilize the drive-thru window when picking up prescriptions, if available.
Medi-Cal members can fill a prescription for up to 100-day supply of medications at retail pharmacies or through our mail service pharmacy. Medi-Cal members should call their pharmacy to ask about mail order pharmacy services.
Can I continue seeing my mental health care provider?
If you are currently seeing a mental health care provider, you can continue to see that provider virtually, such as over the phone or by video. Your standard coverage and out-of-pocket costs apply.
Chinese Community Health Plan – no updates on plan benefits on their website
Health Net of California
https://www.healthnet.com/portal/home/content/iwc/home/articles/coronavirus_COVID-19.action
Does My Plan Cover COVID-19 Testing/Screening Services?
Yes. When medically necessary diagnostic testing or medical screening services
are ordered and/or referred by a licensed health care provider, we will cover
the cost of medically necessary COVID-19 tests and the associated physician’s
visit. If applicable, your plan’s copayment, coinsurance and/or deductible
cost-sharing will be waived for medically necessary COVID-19 diagnostic testing
and/or medical screening services.
Is Prior Authorization Required For COVID-19 Testing/Screening
Services Under My Plan Coverage?
No. We will not require prior authorization, prior certification, prior
notification and/or step therapy protocols for medically necessary COVID-19
diagnostic testing and medical screening services, when medically necessary
services are ordered and/or referred by a licensed health care provider.
Where May I Receive COVID-19 Testing/Screening Services Under My
Plan Coverage?
Medically necessary COVID-19 diagnostic testing and/or medical screening
services and the associated physician’s visit will be covered when ordered,
referred and/or performed in the following In-Network
locations:
- Physician’s/Practitioner’s Office
- Independent Laboratory/Diagnostic Facility
- Urgent Care Facility
- Emergency Department Facility
Are you unsure if you have been exposed to or at-risk of being infected with COVID-19? Schedule a virtual care visit with a provider. It is a good option for non-urgent care to limit potential exposure in a physician’s office or other healthcare facility.
Will I Be Responsible For Any Out-Of-Pocket Costs For COVID-19
Testing/Screening Services?
No. We will cover medically necessary COVID-19 diagnostic testing and/or
medical screening services at no charge to you, when such services are ordered
and/or referred by a licensed health care provider. If applicable, your plan’s
copayment, coinsurance and/or deductible cost-sharing will be waived for
medically necessary COVID-19 diagnostic testing and/or medical screening
services along with the associated physician’s visit.
If I Need Treatment For Coronavirus, Is That Covered By My Plan?
Any medically necessary treatment related to COVID-19 would be considered a
covered benefit. We are committed to ensuring access to COVID-19 treatment
services in accordance with federal and state law.
Will I Be Able To Refill My Prescriptions Before The Refill Date?
Yes, members will be able to refill prescriptions prior to the refill date.
3/10/20
Health
Net statement on cost-sharing for COVID-19
For all members, Health Net is waiving cost-sharing for
medically-necessary COVID-19 screenings, tests and doctor office, urgent care
and outpatient hospital (including emergency departments) visits.
If a member develops symptoms of COVID-19, including fever, cough or shortness of breath, and has reason to believe they may have been exposed, they should call their health care provider or local health department before seeking care. Contacting them in advance will help ensure that people can get the care they need without putting others at risk.
For more information, Health Net members should call 1-800-400-8987.
Kaiser Permanente
https://healthy.kaiserpermanente.org/northern-california/health-wellness/coronavirus-information
Care by phone, online, or in person
You have many ways to get care without leaving the comfort of your home — including phone appointments and email. This allows you to still get great care while helping to address the community spread of COVID-19. If you need to come in, we’re here for you — and we’re taking every precaution to keep our facilities safe.
To book an in-person appointment, or if you’re concerned about your specific health condition, visit kp.org/getcare for your local information on appointments and 24/7 advice.
If you’re a new member and haven’t selected a doctor yet, start by choosing your doctor at kp.org/newmember.
Prescriptions
We’re not experiencing any unusual drug shortages, and you have options for getting the prescriptions you need. It’s a good idea to fill your prescriptions by mail, especially during the COVID-19 outbreak. You can avoid standing in line at the pharmacy, and with most prescriptions you can get a 3-month supply for the price of 2 months.
Sign in to kp.org/rxrefill and select the mail order option. Our pharmacies are experiencing a high volume of refill requests and calls, but we are working as quickly as possible to make sure you receive your mail order within 7 days. For urgent prescriptions, you should visit your closest available Kaiser Permanente pharmacy.
Tests
We’re prepared to test patients for COVID-19 if testing is necessary, per CDC and public health agency criteria. If you’re concerned that you or a family member are exhibiting symptoms of COVID-19, please contact us first before coming in, as you need a referral and appointment to get tested.
As a Kaiser Permanente member, you won’t have to pay for costs related to COVID-19 screening or testing if referred by a Kaiser Permanente doctor. If you’re diagnosed with COVID-19, additional services, including hospital admission (if applicable), will be covered according to your plan details.
Elective surgeries and procedures
The national Centers for Disease Control and Prevention has recommended that all nonurgent procedures be postponed in parts of the country where there’s community transmission of the COVID-19 virus. As a result, Kaiser Permanente will be postponing elective or nonurgent surgeries and procedures in all locations.
We’ll proactively reach out to inform members of the change. If you have an upcoming surgery or procedure, you can also phone or email your doctor’s office with any questions about your ongoing care needs. Once the outbreak has passed, we can work together to reschedule your procedure.
L.A. Care
https://www.lacare.org/members/member-support/health-news-advisories/about-coronavirus
What are options for L.A. Care members?
If you are an L.A. Care member and can’t reach your doctor, you may be eligible to use our telehealth benefit. By using Teladoc®, you can talk to a doctor by phone or video chat in the comfort of your own home.
This option for urgent care can help keep you from being exposed to or spreading the coronavirus, the flu or other illness you might have. Visit the L.A. Care telehealth page to see details and learn how to connect to Teladoc.
L.A. Care members can also order prescriptions online and get them delivered by mail. Visit our Pharmacy Services web page to learn more.
If you are not sure what to do, L.A. Care members can call the Nurse Advice Line at 1.800.249.3619 (TTY 711). Our nurses are available 24 hours a day, seven days a week, and have been staying on top of the latest updates about the coronavirus.
How much do L.A. Care members pay for screening and testing related to COVID-19?
L.A. Care has waived all costs associated with screening, testing and medically-necessary treatment for COVID-19. If you are asked to pay for screening, testing or medically-necessary treatment related to COVID-19, please call the L.A. Care Member Services phone number on the back of your Member ID card.
If you are experiencing symptoms, the CDC recommends contacting your doctor or the Nurse Advice Line before going to your doctor’s office.
Molina
In accordance with Department of Managed Health Care All Plan Letter 20-006, Molina Healthcare is immediately reducing cost-sharing (including, but not limited to, co-pays, deductibles, or coinsurance) to zero for all medically necessary screening and testing for COVID-19, including hospital (including emergency department),urgent care visits, and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.
Oscar
Does Oscar cover COVID-19 testing?
We don’t want cost to be a reason for not seeking care. Oscar is waiving cost-sharing for screening for COVID-19 for all our members, when the test is recommended by a doctor. This includes the cost of the visit associated with testing and the test itself.
If a member has a question about how to find a provider, we encourage them to send their Concierge Team a message from their account on hioscar.com or the Oscar app, or contact us at 855-672-2755.
How will I get my medications? What if my supply runs out?
At Oscar, we’re waiving early refill limits on most prescription drugs at all pharmacies. You can get free refills – up to 90 days for some meds – through Doctor on Call. CVS Pharmacy offers free home delivery for all meds within 1-2 days. Delivery by mail is also an option. To transfer your prescriptions to CVS’s mail-order pharmacy, just call the Oscar/CVS hotline at (855) 796-7227. Once set up, you’ll get a 90-day supply of your meds sent right to your front door.
If you live in the New York City area or Houston, you have one more option: We partner with Capsule Pharmacy to offer free, same-day prescription delivery right to your home. Just select Capsule as your pharmacy in the app, or ask Doctor on Call to send your meds there.
What if I need to see the dentist?
The American Dental Association has recommended that dentists postpone all elective procedures. If you need emergency dental services, you should first contact your provider’s office. The provider will have information about how to arrange emergency services. If a member has a question about how to find a provider for covered dental care, we encourage them to send their Concierge Team a message from their account on hioscar.com or the Oscar app, or contact us at 855-672-2755.
March 13, 2020 – Today, Oscar, a tech-driven health insurance company, launched the first testing center locator for COVID-19 in the U.S., featuring more than 100 centers today. It is accessible to the general public and more testing centers are being added every day.
The testing center locator is the latest update to the tools Oscar is developing in response to member needs as the outbreak evolves. The tool builds on the insurer’s at-home risk assessment survey, also launched this week. Here’s a step-by-step look at the consumer journey to coronavirus planning and care using Oscar’s full-stack tech platform and advanced clinical capabilities:
1. Take Oscar’s risk assessment survey: The clinically-validated tool assesses your risk of contracting COVID-19 to develop your personalized care guide.
2. Find a testing center: If your assessment includes a recommendation to get tested, you’ll be taken directly to the testing center locator to find a center and get instructions for your visit, including the importance of calling ahead to understand center-specific requirements. Oscar is waiving cost-sharing for testing for all members.
3. Follow your assessment recommendations: If you’re not recommended for testing, you can still take action. Your personalized guide includes recommendations on how you can reduce your risk of contracting coronavirus based on factors like your location and age, and whether or not you have any chronic conditions.
4. Discuss your personalized results with a telemedicine doctor: The survey seamlessly links to Oscar’s telemedicine solution, offered at $0 for members for COVID-19 treatment. Members can speak with a Doctor on Call about symptoms, risks, prescriptions and more. Speaking to a doctor is an important piece of assessing risk.
The new testing center locator is based off of information collected directly from Oscar’s provider partners. It is being updated daily as new testing locations are stood up around the country.
Oscar continues to provide updates directly to members and through its COVID-19 resource center, which houses the latest information and guidances on how to help prevent the spread of coronavirus.
Sharp Health Plan
Is testing for COVID-19 covered by my insurance?
Yes. Sharp Health Plan covers COVID-19 screening and/or testing when recommended by your health care provider as medically necessary.
Will I have to pay for COVID-19 testing?
No. Sharp Health Plan has reduced the cost-share (what you pay out of pocket) to $0 for all medically necessary screening and testing for coronavirus. This includes hospital (including emergency department), urgent care, provider office visits, and telehealth appointments for the purpose of screening and/or testing for coronavirus.
Where can I get tested for COVID-19?
If you are concerned about possible exposure to COVID-19, or are experiencing symptoms such as a cough, fever or shortness of breath, call your doctor first. Your doctor will assess your situation and recommend where you should be seen. In some cases, your doctor may recommend that you stay home and treat mild symptoms. Not all patients need to be tested. Testing is provided based on a risk assessment recommended by the CDC.
I’m worried about having enough of my medicine. Can I get early refills?
Yes. You can get early refills of
your maintenance medications (prescriptions commonly used to treat conditions
that are considered chronic or long term) as long as you have pharmacy
benefits through Sharp Health Plan.
We are temporarily relaxing early refill limits on 90-day prescriptions for
maintenance medications at any in-network
pharmacy. Simply tell your pharmacist to use the SCC-13 code when
they process your order. Standard copayments and deductibles (if applicable)
will apply.
Note: This does not apply to refills of controlled substances, such as certain
pain medications. A new prescription from your prescriber is required to
provide an emergency supply of a controlled substance.
I want to stay home as much as possible. Can I get my medication delivered to me?
Yes. If you have pharmacy benefits through Sharp Health Plan, there are two ways to get your medications delivered to you:
- Get home delivery
Many pharmacies are offering free home delivery right now. Please check with your pharmacy for more details on what they may be offering.
- Sign up for mail order
Visit sharphealthplan.com/mailorder to sign up and get your maintenance medications delivered to you. Shipping is always free. Standard co-payments and deductibles (if applicable) will apply.
What is Sharp doing to protect patients, visitors and staff during this time?
Sharp HealthCare’s top priority is the safety and well-being of patients, visitors and staff. Please visit sharp.com/coronavirus for the latest information, such as the following:
- Hospital visitation guidelines
- How Sharp is screening and testing patients
- How to get care
- Infection prevention measures
- Sharp classes and events
We encourage you to check Sharp’s COVID-19 page often for updates.
Where do I get the test if I don’t have insurance?
If you have a primary care doctor, we suggest that you contact your doctor to be evaluated. Not every patient will be tested for coronavirus, so we recommend that you receive an evaluation by a doctor before coming to the hospital or an urgent care center.
If you do not have a primary care physician, we can provide you a referral to a low- or no-cost community clinic.
Does Sharp offer “drive-thru” testing or “testing tents”?
Sharp does not currently provide “drive-thru” testing or “testing tents.” People who think they need to be tested should call their primary care doctor. If appropriate, your doctor will advise you on where to go for testing.
When will Sharp get more tests?
Sharp has established relationships with independent laboratories to help increase testing capacity and decrease test results time. Additionally, we have established the technology platform for internal COVID-19 testing and are awaiting more test kits and chemical reagents to become available to process test samples. Internal COVID-19 testing will allow for turnaround of results in approximately 24 hours.
I don’t work at Sharp and my employer told me that I need to get tested.
Your employer’s occupational health (sometimes called employee health) department can refer you to the occupational medicine program they prefer. Sharp Occupational Health has locations across San Diego. Please have your occupational health or human resources department contact your occupational health provider.
Sutter Health Plus
https://www.sutterhealthplus.org/covid-19-coverage-and-cost
COVID-19 Coverage and Cost
Sutter Health Plus covers medically necessary COVID-19 screening and testing at zero cost to members. We consider services medically necessary if you experience symptoms and meet Centers for Disease Control and Prevention (CDC) criteria for screening or testing. We also defer to the clinical judgement of the treating provider to determine medical necessity. We encourage members to schedule video or telephonic visits to help minimize spread of infection and ease pressure on provider offices, urgent care centers and emergency rooms.
What will my cost sharing be for COVID-19 screening and testing?
There is zero member cost share for medically necessary services related to COVID-19 screening and testing.
What type of services will have zero member cost share?
Common services related to medically necessary COVID-19 screening and testing include, but are not limited to, primary care provider (PCP) office visits, urgent care visits, emergency department visits, telehealth visits, and lab tests.
Will Sutter Health Plus inform providers about the zero cost share requirement?
Yes. Sutter Health Plus notified our medical groups of this information on March 11, 2020.
You can call Sutter Health Plus Member Services at (855) 315-5800. Member Services is available 8:00 am – 7:00 pm, Monday through Friday.
What will my cost sharing be for COVID-19 related treatment?
Standard member cost shares apply to COVID-19 related treatment.
Yes. Sutter Health Plus covers out-of-area urgent and emergent services for our members. Services related to COVID-19 are considered urgent at this time.
What if I cannot get a prescription drug due to a shortage caused by the COVID-19 outbreak?
You can call Sutter Health Plus Member Services at (855) 315-5800. Member Services is available 8:00 am – 7:00 pm, Monday through Friday.
What if I have a clinical concern about COVID-19 or if I experience related symptoms?
You should call your PCP or the Sutter Health Plus 24-Hour Nurse Advice Line for help with clinical questions. You can call Sutter Health Plus 24-Hour Nurse Advice Line at (855) 836-3500.
You also have access to video visits with licensed providers for treatment and advice. Video visits can help minimize the spread of infection and ease pressure on provider offices, emergency rooms, and urgent care centers. Video visits are available 8:00 am – 8:00 pm every day from a smartphone, tablet or computer.
Does Sutter Health Plus offer telehealth services?
Yes. Sutter Health Plus offers you access to telehealth services. We encourage members to schedule video or telephonic visits to help minimize spread of infection and ease pressure on provider offices, urgent care centers and emergency rooms. You can access telehealth services by using:
- Video visits with licensed providers for treatment and advice. Video visits are available 8:00 am – 8:00 pm every day from a smartphone, tablet or computer.
- The Sutter Health Plus 24-Hour Nurse Advice line at (855) 836-3500.
You can also contact your PCP directly to discuss symptoms and additional telehealth options that might be available through their medical group.
Valley Health Plan – no website updates
Western Health Advantage
https://www.westernhealth.com/coronavirus/
COVID-19 Testing
WHA is waiving all cost-sharing for medically necessary screening and testing for COVID-19, including hospital/emergency room, urgent care, and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.
If you think you have been exposed to COVID-19 and develop a fever and symptoms, such as cough or difficulty breathing, call your healthcare provider for medical advice. They will decide whether you need to be tested.
Sacramento County Residents: The COVID-19 Program is currently offering access to a free drive-up coronavirus testing program. Residents who are 18 years of age or older and experiencing mild to moderate symptoms can complete an online screener to determine if they qualify for in-person testing.
Prescription
Medication
WHA is closely monitoring drug shortages listed
on the FDA website. Your pharmacy also has up-to-date information from their
wholesalers regarding drug shortages. If you are affected by a drug shortage,
your pharmacy can assist you or contact your prescribing provider to discuss
alternative treatment options.
If for some reason you are not able to access your current supply of
prescription medications, or if you need an additional supply, you or your
physician can call WHA Member Services to request an early refill at
888.563.2250. Note: CalPERS members should contact OptumRx at
855.505.8110 for early refill requests.
