New York Insurers Required to Waive Cost-Sharing for Coronavirus Testing

March 3, 2020

The New York State Department of Financial Services is requiring New York health insurers to waive cost sharing associated with testing for novel coronavirus, including emergency room, urgent care and office visits.

New Yorkers receiving Medicaid coverage will also not be expected to pay a co-pay for any testing related to COVID-19. These actions are aiming to ensure cost does not serve as a barrier to access to COVID-19 testing for any New Yorker. Currently, all COVID-19 tests being conducted at the state’s Wadsworth Lab are fully covered.

In addition, the state outlined a series of other actions that New York health insurers are required or advised to take, including keeping New Yorkers informed regarding available benefits, offering – where possible – telehealth medical advice and treatment and preparing insurers to cover the costs if a COVID-19 immunization should become available.

“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 Andrew Cuomo said in a DFS press release. “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.”

In order to ensure cost-sharing is not a barrier to testing for COVID-19, DFS will promulgate an emergency regulation that prohibits health insurers from imposing cost-sharing on an in-network provider office visit or urgent care center when the purpose of the visit is to be tested for COVID-19. The regulation also prohibits health insurers from imposing cost-sharing on an emergency room visit when the purpose of the visit is to be tested for COVID-19.

The State Department of Health will ensure New Yorkers receiving Medicaid coverage have their costs covered. New Yorkers enrolled in self-funded employer-based health insurance plans that are not regulated by New York state due to the Employee Retirement Income Security Act of 1974 (ERISA) should contact their employer to fully understand the scope of coverage.

In addition to covering the cost of testing, the guidance issued by DFS to health insurers regarding actions they should take in relation to the potential impact of COVID-19 on New York includes:

  • Keeping consumers informed: DFS is directing insurers to devote resources to inform consumers of available benefits, quickly respond to consumer inquiries, and consider revisions needed to streamline responses and benefits for consumers.
  • Providing telehealth medical advice and treatment: DFS is directing insurers to develop robust telehealth programs with their participating providers where appropriate, particularly for individuals who may have difficulty making an office visit and where a phone call with a medical professional can alleviate the need for a hospital visit.
  • Preparing the health system for increased cases: DFS is directing insurers to verify that their provider networks are adequately prepared to handle a potential increase in the need for health care services, including offering access to out-of-network services where appropriate and required, in the event more COVID-19 cases are diagnosed in New York. In addition, DFS is reminding insurers that lifetime or annual limits cannot be placed on in-patient care.
  • Covering costs if immunization becomes available: In the event an immunization becomes available for COVID-19, DFS is reminding insurers that they must cover the cost of vaccination for children under 19. For adults, DFS’s guidance states all insurers should be prepared to cover the immunization immediately at no cost-sharing.
  • Expanding access to prescription drugs: With reports of prescription drug shortages due to supply chain issues, DFS is directing insurers to provide insurance coverage for off-formulary prescription drugs if there is not a formulary drug available to treat the insured, through a formulary exceptions process as required by law.
  • Ensuring emergency care: DFS is reminding insurers that coverage for emergency services in hospital facilities is required at the in-network cost-sharing even if the hospital is out-of-network or overseas, and that no insurer may require a patient to seek preauthorization prior to seeking emergency care, including for ambulance service.
  • Surprise medical bills: DFS is directing insurers that they are required to hold harmless insureds who receive surprise medical bills for health care services, including those related to testing and treatment of COVID-19.

“New York State has been prepared for the potential spread of coronavirus, taking steps to prepare our health-care system and ensure our residents are protected and know the facts,” said DFS Superintendent Linda A. Lacewell in the release. “Insurers need to do all they can to support consumers and the public health as we take action to address coronavirus. Removing barriers to testing will strengthen the system for everyone and potentially keep overall costs down as people get the help they need.”

Source: New York State Department of Financial Services

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