Insurance commissioner urges insurers to cover Coronavirus testing

BISMARCK – Insurance Commissioner Jon Godfread on Wednesday issued a bulletin Wednesday to all North Dakota health and travel insurance companies, urging them to waive cost sharing requirements for the testing of COVID-19 and encouraging health insurance companies to review other operations in preparation for COVID-19 potentially coming to North Dakota.

“Our health insurers have assured me that they are prepared and will continue to monitor the developments here in North Dakota and across the country,” Godfread said. “This bulletin is a collaborative effort with our industry and to their credit they have been great partners in making sure North Dakota consumers have access to the testing they need. This has truly been an all hands-on deck scenario, which is to the benefit of North Dakota consumers.”

The bulletin outlines ten measures that the industry will be taking or plans to take as COVID-19 continues to progress. Those points include:

– Preparedness. Health carriers should review their internal processes and operations to ensure that they are prepared to address COVID-19 cases in North Dakota, including providing insureds with information and timely access to all medically necessary covered health care services.

– Information Access. Health carriers are asked to inform insureds of available benefits, quickly respond to insured inquiries, and consider revisions needed to streamline responses and benefits for insureds.

– Testing. The Department asks health carriers to waive cost-sharing, including co-pays, deductibles and coinsurance for CDC-recommended laboratory testing of COVID-19 so that the cost sharing does not serve as a barrier to access to these important tests. In addition, health carriers are also asked to waive the cost-sharing for an in-network provider office visit, urgent care center visit and an emergency room visit when testing for COVID-19. Waiving cost-shares may be done on a retrospective case-by-case basis upon a confirmed COVID-19 diagnosis.

– Telehealth Delivery of Services. Given that COVID-19 is a communicable disease, some insureds may be using telehealth services instead of in-person health care services. Health carriers are asked to review and ensure their telehealth programs with participating providers are robust and will be able to meet any increased demand.

– Network Adequacy and Access to Out-of-Network Services. If a health carrier does not have a health care provider in its network with the appropriate training and experience to meet the particular health care needs of an insured, health carriers are asked to make exceptions to provide access to an out-of-network provider at the in-network cost-sharing.

– Prior Authorization. Health carriers are asked to waive any prior authorization requirements associated with COVID-19 testing or treatment.

– Immunizations. In the event an immunization becomes available for COVID19, the Department requests that health carriers immediately cover the immunization at no cost sharing for all covered members.

– Access to Prescription Drugs. Health carriers are asked, where appropriate, to make expedited formulary exceptions if the insured is suffering from a health condition that may seriously jeopardize the insured’s health, life, or ability to regain maximum function or if the insured is undergoing a current course of treatment using a non-formulary prescription drug.

– Surprise Medical Bills. The department is requesting out-of-network providers and facilities to accept the highest of the health carrier’s in-network reimbursement as full and final payment and to hold harmless insureds who receive surprise medical bills for health care services as it relates to testing and treatment of COVID-19. In order to protect consumers from unexpected out of pocket costs, the North Dakota Insurance Department encourages providers to use the insured’s in-network laboratory facilities.

– Travel Insurance. Unless a travel insurance policy contains an exception applicable to COVID-19, a policy must cover such risks relating to COVID-19.