NJ Healthcare Insurers Waive COVID-19 Fees

On Mar 9, 2020

With daily reports of increasing COVID-19 cases in the state, a number of healthcare insurance companies are waiving prior authorizations for visits to healthcare providers and covering the full cost of COVID-19 testing.

On Friday, Horizon Blue Cross Blue Shield of New Jersey  – the state’s largest healthcare insurer –  announced it will waive prior authorizations for a visit to a primary care physician, urgent care center, or emergency room for evaluation of upper respiratory symptoms, fever, shortness of breath or other conditions that may represent COVID-19. It is also waiving prior authorizations for diagnostic tests and covered services that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. Prior authorization for lab studies or diagnostic testing required during an ER evaluation or inpatient hospital stay, will also be waived.

The company will additionally cover the full cost of the COVID-19 test and waive early medication refill limits on 30-day prescription maintenance medications (consistent with a member’s benefit plan) and/or encourage members to use 90-day mail order benefit. Horizon will also ensure formulary flexibility if there are shortages or access issues and not hold patients liable for additional charges stemming from obtaining a non-preferred medication resulting from shortages or access issues.

Horizon members will also have no cost, 24/7 access to licensed nurses who can assess and assist members with symptoms that are consistent with suspected COVID-19 infection. Those service are available through the company’s free “Horizon Blue” app, the www.HorizonBlue.com online portal, or by phone at 1-888-624-3096.

“The health and well-being of our members is our top priority.  These steps will help them access the care they need with coverage that reflects the unique situation created by COVID-19,” said Kevin P. Conlin, chairman, president and CEO of Horizon BCBSNJ.  “We’re working closely with our customers, the state’s public health leadership, and our provider partners across New Jersey to prepare, and these first steps reflect our readiness to adapt to the situation as it evolves.  In addition to the changes we are making for our insured members, Horizon will continue to work with our self-insured customers on their specific plan designs. Our members and customers can rest assured that Horizon is responding to this emerging public health threat.”

Meanwhile, AmeriHealth New Jersey announced on Saturday that it will cover and waive cost-sharing (such as co-pays and coinsurance) for the COVID-19 test when performed at a hospital or an approved laboratory. This includes members enrolled in AmeriHealth’s fully insured plans, employer-sponsored plans and the individual and family plans available through the Affordable Care Act. Self-funded plans will be able to opt-out of this program, according to the company.

Given that the test is new and specific billing codes for commercially available tests were only recently designated, AmeriHealth members should report any concerns about claim payment to the company’s customer service staff at the number on their member card. At this time, the Centers for Disease Control and Prevention (CDC) and state labs currently performing the testing are not billing for COVID-19 testing, so members should not incur costs when tested by these labs.

To help reduce potential exposure, AmeriHealth New Jersey also encourages members to utilize telemedicine services if they are available as part of a member’s plan. To encourage use of these services, AmeriHealth New Jersey will waive member cost share where applicable for telemedicine visits for the next 90 days. To access telemedicine options, members should login to our member website at amerihealthnj.com.

Aetna announced it will also waive co-pays for all diagnostic testing related to COVID-19. This policy will also over the cost of physician-ordered testing for patients who meet CDC guidelines, which can be done in any approved laboratory location. Aetna will waive the member costs associated with diagnostic testing at any authorized location for all commercial, Medicare and Medicaid lines of business. Self-insured plan sponsors will be able to opt-out of this program at their discretion.

For the next 90 days, Aetna will offer zero co-pay telemedicine visits – for any reason. The company advises members to use telemedicine as their first line of defense in order to limit potential exposure in physician offices. Cost sharing will be waived for all video visits through the CVS MinuteClinic app, Aetna-covered Teladoc® offerings and in-network providers delivering synchronous virtual care (live video-conferencing) for all commercial plan designs. Self-insured plan sponsors will be able to opt-out of this program at their discretion.

UnitedHealthcare will also waive member cost sharing, including copays, coinsurance and deductibles, for COVID-19 diagnostic testing also provided at approved locations in accordance with CDC guidelines for all commercial insured, Medicaid and Medicare members. UnitedHealthcare is also working to support self-insured customers who choose to implement similar actions.

Meanwhile, Cigna will also waive all co-pays and cost-shares for Coronavirus testing for its customers that is recommended by their health practitioners.

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