Category: Health and Wellness, Health Insurance

Your Blue Cross Health Insurance Coverage in June 2020

As we made our way through March, April and May 2020, we saw the number of COVID-19 cases in Louisiana rising very quickly, especially before the governor issued his “stay-at-home” order on March 22.

In response to this unprecedented health crisis, health insurance companies like Blue Cross and Blue Shield of Louisiana began to add, amend and alter their coverage to make it easier for people to get tested and treated for COVID-19. At Blue Cross, we also made changes to make it easier for people to get healthcare treatment while staying at home.

Some of these changes were due to state regulations changing, some were due to federal regulations changing and some we did just because it was the best thing to protect our members from COVID-19 and to make sure they got the best treatment available.

Now that we are in June and as of this writing, COVID-19 hospitalizations have dropped from around 2,200 people statewide to fewer than 600 and people on ventilators have moved downward from more than 500 to fewer than 80, this is a great time to revisit our coverage changes for members and explain which ones are still in effect.

COVID-19 Testing Still Covered at 100%

U.S. Food & Drug Administration (FDA)-approved COVID-19 testing is still not subject to any pre-authorization, and it’s still covered at $0 for members. That’s been in place since March 18 and has not changed. It is currently in place through the end of next year and also covers the doctor’s appointment where your provider orders that test.

I’ve heard at least one story where a doctor didn’t code the visit with just the right code to link it to the test, so the doctor’s visit wasn’t covered at full cost. If that happens to you, we are happy to help you and your provider straighten that out. Just call Customer Service at the number on the back of your ID card.

Every medically necessary antibody test is still covered at full cost for now, but we are waiting on clarification from at least one agency about exactly which tests fall under this category, so that could change. We will not cover antibody testing used as part of a ‘return-to-work’ strategy. You can see our Senior Medical Director, Dr. Dee Barfield, explain why there is currently no test – antibody or otherwise – that says for sure it’s safe to go back to work in this video (2:41). If your employer asks you to have an antibody test before returning to work, check with your employer to ask how the testing process will work and what you are expected to do.

So, if you have symptoms associated with COVID-19 and you go to your doctor or an urgent care, and they decide you need to have a COVID-19  test, you won’t have to pay any copays or deductibles for that medically necessary test and visit.

COVID-19 Treatment is Authorized

You can access COVID-19 treatment currently without any prior authorizations from Blue Cross. We are revisiting that monthly, so that could change. Your treatment is now subject to normal cost sharing like copays, deductibles, and coinsurance. How much that is depends on your plan type and benefits. Be sure to check your policy for more details about your financial responsibility if you need care.

Telehealth and In-Home Visits Still Happening

Telehealth services like BlueCare are still up and running very well. Online behavioral health appointments are now available via BlueCare. Your regular healthcare providers may also offer visits via telehealth. Telehealth visits are subject to your usual copay and deductible charges as of June 1, 2020. Be sure to check your plan documents for more information.

Blue Cross is still covering in-home visits from in-network physical, occupational, or speech therapists, so our members can continue to access these services without having to go to a clinic or healthcare facility. Regular cost-sharing applies.

Getting Your Prescriptions Filled

As of June 1, 2020, it’s pretty much business as usual at the pharmacy. Regular refill limits, step therapy applications, all the usual things when drugs are prescribed still apply. We may have a different conversation about drugs when a COVID-19 vaccine is available and the FDA approves it. We often waive refill limits when there is a tropical storm or hurricane brewing, so that is subject to change during the next few months. But I don’t foresee us changing for COVID-19 again.

Hey Mike, I got charged for something that should have been $0!

I’ll be the first to admit, in March, April and May, the people who tend to our systems that pay claims and manage cost-sharing were pushed hard with changes, (often conflicting changes) coming in from state and federal officials, and even our own leadership as we learned more about what was best for our members in fighting off COVID-19. And it takes several days or even a couple of weeks to change our systems after a new rule is put in place.

It’s entirely possible that a member got a bill or got charged for something that should have been covered 100%. If that happened to you, DON’T PANIC! Just grab your Blue Cross card and call the number on the back. Customer Service wants to help and will talk to you about setting that straight.

We tried really hard to make all those changes and make them all work in time, but we probably missed a few. Don’t forget that we were moving almost our entire workforce out of their offices and to work-from home at the exact same time all this was happening.

We’re way more settled now, and ready to deal with any problems you might have had.

If you got a charge that you think should have been $0, don’t stew about it; give us a call right away, and we’ll go through the new rules and charges and set things right for you.

Straight Talk is, a lot has changed because of COVID-19, and I’m here to help you keep up with it all.

Thanks for reading Straight Talk!

Posted on: June 11, 2020

2 comments on “Your Blue Cross Health Insurance Coverage in June 2020

  1. Jerri Burns

    As healthcare providers, we have employees that may be exposed to Covid-19 frequently. We are also required to make patient visits in nursing facilities that are now requiring our employees to have a negative Covid-19 test every 2 weeks to enter their facility.
    If our employees need to be tested due to exposure or due to requirements from our contracted nursing facilities, is there a limit to how often or how many times insurance will cover the co-pay? Are all test covered at no cost to members? Rapid test? 24 hr test? etc
    Thank you for your time and attention to this most important matter.

    Reply
    • Michael Bertaut

      At this time, the Feds and State have spoken with regard to when Covid-19 tests are covered by your insurance plan, and when they are essentially given and the visit covered at $0.

      IF a visit to a primary care provider, urgent care, or ED results in an evaluation that leads that provider to perform a COVID-19 test (and code it properly, btw) because CDC guidelines say it is appropriate, then typically the test is performed at $0 co-pays.
      Other testing outside of that setting are typically subject to normal benefits like any other medical test (deductibles, co-pays, coinsurance) and this depends on the health plan you have. If you are on an employer health plan, you can call the number on the back of your card or go through your employee benefits department if your employer sponsors a self-funded health plan.

      Health plans do NOT, in general, cover COVID-19 testing or antibody testing as a condition of employment. That is not part of the mandate.
      Hope that helps….mrb

      Reply

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