Albany, NY (WorkersCompensation.com) – Democratic Gov. Andrew Cuomo announced recently that new regulations in the state will require insurers to pay for coronavirus (COVID-19) testing and treatment. Under the emergency directive from the New York State Department of Financial Services, the state’s insurers are required to dismiss patient responsibility such as coinsurance, copays, and deductibles. Furthermore, insurers have been asked to hold harmless those patients who have received surprise medical bills, including those related to COVID-19.
While the new regulation applies to insurers in the state, it does not apply to self-funded employer coverage as those are governed by the Employee Retirement Income Security Act of 1974 (ERISA). Those patients will need to address any coverage issues with their employer.
The new regulation applies to not only testing, but emergency room, urgent care, and office visits as well that are related to COVID-19 treatment. Additionally, insurers are not allowed to require a prior authorization for emergent care including ambulance services. All hospital services will be required to be processed at in-network levels of benefits.
The state has asked insurers to ramp up their telehealth programs to keep patients from going to the hospital. Insurers have also been asked to verify with their provider networks that they are capable of handling an increase of cases, and to make arrangements for potential out-of-network scenarios. Insurers have also been asked to keep their consumers informed of available benefits. Along those same lines, insurers have been asked to reduce their response time to inquiries and modify their processes to streamline them if necessary.
If a vaccine is developed for COVID-19, the state has indicated that insurers should be ready to cover that cost immediately as well. In light of drug shortages, the state is urging insurers to cover off-formulary prescription drugs in cases where the preferred drug is not available.
One reason for the emergency regulation is that large costs are considered to be a barrier for obtaining treatment. In a recent a New York Times report, American citizens in China were evacuated and quarantined due to the COVID-19 virus. Although the evacuation and treatments were the result of a government mandate, some of those families have been left with unexpected medical bills as a result.
“We have the best health-care system in the world, and we are leveraging that system including our state-of-the-art Wadsworth testing lab to help contain any potential spread of the novel coronavirus in New York,” Governor Cuomo said. “Containing this virus depends on us having the facts about who has it – and these measures will break down any barriers that could prevent New Yorkers from getting tested.”
The Center For Disease Control is hosting regular webinars to keep providers informed of the latest developments related to COVID-19.