Stepping up on coronavirus treatment coverage

Self-insured employers, feds need to do their part

THE MASSACHUSETTS DIVISION of Insurance issued a bulletin late last week that strongly suggests health insurers should cover coronavirus testing without copayments, deductibles, or co-insurance and treatment without copayments.

Andrew Dreyfus, CEO of Blue Cross Blue Shield of Massachusetts, and Lora Pellegrini, CEO of the Massachusetts Association of Health Plans, publicly stated that the state’s health insurers will abide by the Division of Insurance proposal, which technically is not legally binding on them.

Many insurers have also pledged to make telehealth services available to members and will waive copayments for telehealth visits with primary care physicians and specialists. A number of health plans are also increasing access to prescription medications by waiving early refill limits on 30-day prescription maintenance medications. Likewise, some health insurers are even making 90-day maintenance medication prescriptions available to members at the pharmacy or through mail-order.

Clearly, it seems that insurers understand the public health imperative that you don’t want to deter people, with symptoms of COVID-19 illness, from coming forward for testing and/or treatment simply because they are worried about their out-of-pocket costs in doing so.

My question is this: Will our self-insured employers and the federal government step up in a similar fashion?

Most people in Massachusetts who have what looks like a private health insurance card in their pocket are actually insured by their employer. Hopefully, these employers will pick up the same sort of out-of-pocket coronavirus related costs, so their employees don’t have to.  While I realize that not all self-insured employers have deep pockets,  this is a time for them to step forward to financially protect employees and their families and, if need be, make some financial adjustments next year.

In addition, we await federal guidance for Medicare, Medicaid, and federally prescribed high deductible products. State law doesn’t impact these product types.

On the provider side, in what may be a period of calm before the storm, I would like to see some commitments from them as well. With or without state regulatory oversight, there should be no price gouging or windfall profits resulting from the outbreak of COVID-19.

First, providers should follow Centers for Disease Control guidelines in virus testing and treatment, and they should use appropriate billing codes that have been developed for the coronavirus.

Second, fully insured individuals  in our state should be  protected from surprise bills and facility fees for COVID-19 care from an out-of-network provider. Surprise billing and facility fees hurt consumers and raise health insurance premiums.   There is no reason, especially at a time of state emergency, to add additional pain by paying huge out-of-network fees to clinicians who are not under an insurance contract or facility fees for treatment beyond a hospital campus.

While the broader issue of surprise billing is being debated in the Legislature, let’s at least create a reasonable fee schedule for all COVID-19 illness care that would be in effect until the end of this year.  The Department of Public Health and the Division of Insurance may need to work together to make this happen.

Finally, while a vaccine is at least a year and half away, there are some COVID-19 treatments that are in development and could even become available before the end of the year.  Pharma companies that make these products, along with private labs and health care providers, need to refrain from making their financial gain a priority over patient access to affordable care.

Working people, who are stressed already by health care affordability, may feel even more pressure when they lose wages from cancelled work, dealing with their own illness, or caring for a loved one.

Meet the Author

Paul A. Hattis

Associate professor, Tufts University Medical School
This is surely a time for putting people over profits and working together to eradicate this pandemic.

Paul A. Hattis is an associate professor at Tufts University Medical School.