States, Insurers Move to Limit Coronavirus Testing Costs for Patients -- 2nd Update
March 05 2020 - 8:11PM
Dow Jones News
By Anna Wilde Mathews
States are moving to block insurers from charging members for
coronavirus testing, putting pressure on the industry to ease costs
that might discourage people from getting diagnosed and
treated.
As California and Washington on Thursday became the latest state
to require that insurers make the testing free for their customers,
the industry began taking voluntary steps.
Cigna Corp. said that in its plans nationwide, it would waive
consumers' out-of-pocket costs for lab tests to diagnose infection
from the novel virus, treating the tests like other types of
preventive care that are free to members. Though these tests are
already free when performed by the Centers for Disease Control and
Prevention, they are expected to be offered more broadly by
commercial labs that could charge. Consumer advocates have raised
concerns that people might delay or decline testing for fear of
high costs.
Cigna said the free lab test setup will apply in its fully
insured plans, including employer and individual coverage, Medicare
Advantage and Medicaid. Self-insured employers will have the option
to offer the tests free of charge to their workers.
"We will do everything we can to help contain this virus, remove
barriers to testing and treatment, especially for seniors and
people who are chronically ill, and give peace of mind to those we
serve," said Cigna Chief Executive David M. Cordani.
The orders from California and Washington state were broader.
Washington's insurance regulator said insurers must cover, without
copayments or other cost-sharing for patients, a health-care
provider visit and testing for any member who meets the CDC's
guidelines for testing for the novel coronavirus. The cost would
also be paid by the plan upfront before the patient's deductible is
applied.
California said insurers would waive all cost-sharing for the
testing, as well as urgent-care, emergency-room or doctor office
visits for coronavirus screening and testing for people who need
it.
The latest announcements follow similar actions in New York and
Missouri.
America's Health Insurance Plans, a trade group representing
health insurers, said its members want to ensure that consumers
don't face barriers to testing or care, and will "take action to
ease network, referral, and prior authorization requirements and/or
waive patient cost sharing."
Other states are weighing similar moves. In Rhode Island, where
at least two people have been confirmed infected, the state
insurance regulator is considering whether to ask or potentially
require insurers to waive cost-sharing for coronavirus testing,
according to a spokesman. "We want to be sure we have an effective
response," he said. The regulator is meeting with insurers
Friday.
The states are taking action amid concerns that consumers, even
those with insurance, might avoid getting tested or treated because
they would face large out-of-pocket costs. In a poll in March of
last year, the Kaiser Family Foundation found that more than half
of U.S. adults said they or a family member had put off health care
due to costs. Among those with insurance, 34% said it was difficult
to pay the cost of their deductibles.
Washington's insurance regulator also told insurers that they
must allow access to out-of-network health-care providers at
in-network rates if members can't get testing and treatment for
Covid-19, the respiratory illness associated with the coronavirus,
from doctors and hospitals included in their plans.
However, the state orders waiving cost-sharing have limits. They
focus on diagnosis, not treatment of Covid-19. While most people
generally see mild effects, older people and those with underlying
health conditions have in some cases needed extensive, and costly,
hospital care.
Also, state insurance regulators only oversee certain types of
coverage -- they don't generally regulate Medicare or self-insured
plans, which most large employers have.
It is too early to determine the financial impact the moves to
waive cost-sharing could have on insurers. But it might be blunted
because the efforts are limited to testing and diagnosis, and
because the state moves, which are only in a few places so far,
don't apply to all coverage, said Deep Banerjee, an analyst with
S&P Global Ratings. Still, "if the cost includes more visits to
high-cost facilities, that could be impactful," he said.
It also remains to be seen if regulators can ease concerns when
people are covered by skinny plans that might only pay out a
limited amount or not cover certain types of care. Some short-term
plans don't cover drugs, for instance, or might pay only a set fee
toward hospital or other care, leaving a consumer to shoulder the
rest of the cost.
Insurance regulators also don't have power over health-care
sharing ministries, which are supposed to help their members share
medical costs. These ministries, which have been growing their
enrollment in recent years, aren't insurance and typically don't
guarantee they will cover all types of expenses -- nor do they have
regulatory requirements to stockpile financial reserves.
Write to Anna Wilde Mathews at anna.mathews@wsj.com
(END) Dow Jones Newswires
March 05, 2020 19:56 ET (00:56 GMT)
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