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What insurers are covering during the COVID-19 pandemic

Hospitals can transfer patients who are COVID-negative to post-acute care facilities without advanced prior authorization approval, AHIP says.

Susan Morse, Managing Editor

America's Health Insurance Plans today released actions health insurers are taking to meet the coronavirus pandemic.

To guard against premium increases, in a letter to Congress, AHIP proposed having a special exchange enrollment period, making direct support to small businesses and funding the uninsured. The cost of COVID-19 testing and treatment could lead to premium increases for employers in 2021.

Another issue during the crisis is provider capacity. Insurers have come under fire from some physicians and others who've said transfers are being delayed due to prior-authorization delays from commercial insurers.

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"Our hospital floor is full and we need open beds for the imminent COVID surge. But multiple patients of mine can't leave the hospital because they're awaiting prior auths from commercial insurers," tweeted Augie Lindmark, resident physician at the Yale School of Medicine.

AHIP said insurers are partnering with hospitals to simplify and accelerate the discharge and transfer of patients from hospitals to a post-acute care facility or home. The AHIP Board of Directors, which met Monday night, released this statement: "Patients who can be treated safely in alternate sites of care for post‐acute care services should be quickly moved to those facilities. That means inpatient hospitals can transfer patients that are COVID negative or are treated in regions with capacity challenges without advanced approval to any alternate post‐acute care facilities that are safe, medically appropriate and readily available (e.g., Home Health, Long Term Acute Care Hospitals, Skilled Nursing Facilities, and others) until this crisis is resolved." 

To clarify what insurers are covering, here's a list:

  • Testing. This is being done at no cost to patients, with no copay, no coinsurance required.
  • Treatment. Treatment is covered, though there is currently no vaccine or treatment available, other than drugs that are being tested. Health plans are covering the doctor visits and treatments needed to recover from the disease. 
  • Prior Authorization. Prior authorization is being waived for those seeking testing or treatment of COVID-19, to speed access to appropriate treatment, AHIP said.
  • Telehealth. Telehealth cost-sharing services have been waived, facilitating care for Americans who are at home and need care without exposing healthcare workers or patients to the disease.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com