COVID-19 screening and testing for commercial health insurance

The California Department of Insurance (CDI) has issued a directive to all insurers providing commercial health coverage regarding steps to ensure that cost does not interfere with availability of COVID-19 testing.

CDI directs all insurers providing commercial health coverage to: 1) reduce cost-sharing to zero for all medically necessary screening and testing for COVID-19, 2) notify the plan’s contracted providers that the plan is waiving cost-sharing, 3) ensure that the plan’s advice nurse line and customer service representatives are so informed, 4) inform the insurer’s call center staff to advise their insureds to call their provider’s office or advice nurse line for instructions about how to best access care for screening and treatment of COVID-19, and 5) prominently display on their websites that cost-sharing for medically COVID-19 screening and testing is waived.

CDI reminds insurers that they: 1) must cover all medically necessary emergency care without prior authorization, 2) comply with utilization review timeframes for approving requests for urgent and non-urgent services, 3) ensure their provider networks are adequate to handle an increase in need for services and 4) ensure enrollees are not liable for balance billing.

CDI encourages plans to work with contracted providers to use telehealth services when medically appropriate, and to waive prior authorization and/or step therapy requirements if the provider recommends the enrollee take a different drug and there is a shortage of any particular prescription drug.  (CDI Bulletin, COVID-19 Screening and Testing, March 5, 2020.)