Pennsylvania’s Governor rolled out a notice outlining proactive steps and recommendations for consumers and major health insurers to help mitigate the potential impact the coronavirus situation in the region, Your Content has learned.
“The commonwealth remains laser-focused on mitigation of COVID-19,” Gov. Wolf said. “Posting these recommendations for health insurers further reinforces our commitment to making sure all Pennsylvanians have the health care they need during this uncertain time.”
“Health insurance coverage plays a critical role in the affordability and access to health care services,” said Altman. “We must all be prepared to address this public health crisis, and that includes continually assessing and making adjustments to increase access to necessary care for Pennsylvanians.”
Notice Regarding Coronavirus (COVID-19) Insurance Coverage, provides several recommendations for health insurers, including:
- Providing access to accurate information, informing insureds of available benefits and quickly responding to inquiries about coverage.
- Providing telehealth delivery of services instead of in-person health care services and being prepared to meet any increased demand for that means of delivery.
- Verifying provider networks are adequate to handle a potential increase in the need for health care services related to COVID-19.
- Easing preauthorization requirements, so that they are not a barrier to access necessary treatment for COVID-19, and being prepared to expedite utilization review and appeal processes for services related to COVID-19.
- Easing access to prescription drugs, making expedited formulary exceptions, and permitting the temporary use of out-of-network pharmacies (at in-network cost-sharing) in the event of medication shortages at in-network pharmacies.
Major health insurers in Pennsylvania have announced they are taking the necessary steps to cover medically appropriate COVID-19 diagnostic testing and associated treatment for consumers, and have committed to waive any cost-sharing for the testing.
This increased access to testing is especially critical as multiple commercial medical labs are in the process of implementing testing capabilities and some have begun to perform tests.
“All of the major insurers in Pennsylvania’s market have already stepped up and made proactive announcements to ensure access to medically recommended health care services and testing related to COVID-19,” added Altman. “This bulletin further outlines areas where I am asking insurers to be vigilant and take additional steps as needed in their responses to COVID-19.”
The department encourages patients to be aware of steps their insurance company is taking to increase access to necessary care related to coronavirus.
Consumers with excepted benefit policies, short-term, limited duration health insurance coverage, and/or health care sharing ministries, need to understand these plans can have significant limitations on coverage and may not provide the same level of access.
Self-funded coverage, which is not within the department’s regulatory jurisdiction, may also have different limitations. However, the department is encouraging health insurers to coordinate closely with the business they administer on behalf of employers who self-fund their health benefits to ensure consistency in access across all forms of coverage.
“The opportunity to conduct in-state testing without putting the financial burden on consumers allows us to better identify those at risk,” said Secretary of Health Dr. Rachel Levine. “Removing the financial consumer obligations associated with tests and care will allow more individuals with symptoms to come forward and be tested.”
The Insurance Department, in partnership with the Departments of Health and Human Services, developed an FAQ that provides information and answers to common questions related to insurance coverage and COVID-19.
For up-to-date information on COVID-19 in Pennsylvania, visit the PA Department of Health’s dedicated Coronavirus webpage that is updated daily.
The Pennsylvania Insurance Department has a consumer services team available to answer questions about insurance coverage and benefits at (877) 881-6388. PID may also provide assistance if a consumer receives an unexpected bill related to COVID-19, or other health care services.
The recent widespread outbreak of the respiratory disease stemmed from a novel coronavirus that was first detected in China and which has now been detected in 60 locations internationally, including in the United States.
Coronaviruses are a large family of viruses that are common in people and many different species of animals, including camels, cattle, cats, and bats.
During the week of February 23, CDC reported community spread of the virus that causes COVID-19 in California (in two places), Oregon and Washington. Community spread in Washington resulted in the first death in the United States from COVID-19, as well as the first reported case of COVID-19 in a health care worker, and the first potential outbreak in a long-term care facility.
The CDC affirms that there are ongoing investigations to learn more. This is a rapidly evolving situation and information will be updated as it becomes available.
How will the coronavirus impact my community?
More cases of the coronavirus are likely to be identified in the coming days, according to the CDC. That includes a rapid increase in cases in the United States. It’s also likely that person-to-person spread will continue to occur, including in communities in the United States. It’s likely that at some point, widespread transmission of the coronavirus in the United States will occur.
Widespread transmission of the coronavirus would translate into large numbers of people needing medical care at the same time. Schools, childcare centers, workplaces, and other places for mass gatherings may experience more absenteeism. Public health and healthcare systems may become overloaded, with elevated rates of hospitalizations and deaths. Other critical infrastructure, such as law enforcement, emergency medical services, and transportation industry may also be affected. Health care providers and hospitals may be overwhelmed. At this time, there is no vaccine to protect against the coronavirus and no medications approved to treat it. Nonpharmaceutical interventions would be the most important response strategy.
The last several weeks have witnessed a series of riveting coverage for what has become a global pandemic. Your Content has followed the vital topics from readers throughout the nation, who provide us with first-hand content by the hour. Among our recent revelations:
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