Health insurance providers act fast as part of the COVID-19 solution

Health insurers have a vital role to play amid the COVID-19 crisis, as many Kentuckians are not only fearing the coronavirus, but the medical bills that may accompany it. To look at Kentucky’s response to the crisis, Medical News spoke with a few insurance providers across the commonwealth.

Medical News: How is your organization adjusting from an operational standpoint?

Stephen Friedhoff, MD, Chief Clinical Officer, Anthem

Currently, all associates who have the capability to work from home are doing so, and we implemented a thoughtful, phased approach to migrate additional associates to a work at home environment in a manner that will protect their safety and maintain a seamless experience for those we serve.

For those few who are working in our offices, we are instituting all CDC-recommended social distancing practices.

Michael Taylor, president, Kentucky and West Virginia Markets, CareSource

We have seamlessly transitioned our workforce from an office environment to working from home across all five states we support.

During this crisis, our staff has embraced the challenges and worked through solutions to ensure access to healthcare where needed. We have continued to work proactively to identify and resolve issues like re-configuring some of our claims payment systems to accommodate the rapidly changing requirements.

Kate Marx, Humana

For Humana health plan members, we waived their costs for testing and treatment related to COVID-19. Costs related to coronavirus–including inpatient hospital admissions–will be waived for enrollees of Medicare Advantage plans, fully insured employer health plans, Medicare Supplement and Medicaid. The waiver applies to all medical costs related to the testing and treatment of COVID-19 as well as FDA-approved medications or vaccines when they become available.

The company is also allowing early prescription refills, so members can prepare for extended supply needs – an extra 30- or 90-day supply as appropriate. Plus, Humana is providing a member-support line with specially trained call center employees to help support members with specific coronavirus questions and concerns, including live assistance with telehealth.

Kim Sonerholm, CEO, UnitedHealthcare of Kentucky

We have mobilized the full strength of our resources to deliver the best care for patients, support our members and care providers and deliver innovative solutions.

These efforts include instituting a work-from-home policy for those not serving patients in hospitals or clinics and not deemed essential to operations; assisting the federal government in distributing emergency funding to healthcare providers seeking assistance under the CARES Act; pioneering a non-invasive, self-administered COVID-19 test that streamlines testing, reduces PPE usage and increases safety of healthcare workers; and investing an initial $70 million to fight the COVID-19 pandemic and support those most directly impacted by the public health emergency.

Bill Jones, CEO, WellCare of Kentucky

Operationally, we are looking at each department, each team, each program, and asking, “how can this be adapted?” For some of our services, that has meant reducing paperwork or streamlining processes to maintain easy access to care; for others, we have focused on embracing digital platforms or creative uses of technology to keep programs running. Our priority is finding solutions to continuing these essential services.

Internally, except for a few core personnel that attend to mail or facility operations, we have been under a strict work from home policy for over a month.

Medical News: What innovative steps are you taking to ensure that patients have access to care?

Stephen Friedhoff, MD, Anthem

We developed a Coronavirus Assessment tool, which is available on Sydney Care, our digital care access platform, at no cost. The assessment uses risk evaluation tools based on guidelines established by the CDC to help individuals quickly and safely evaluate their symptoms and assess their risk of having COVID-19. Based on the results, Anthem affiliated health plan members can connect directly to a board-certified doctor via text or secure two-way video who can then offer care options.

LiveHealth Online (LHO), our telehealth service, is a safe and helpful way to use their benefits to see a doctor and receive health guidance related to COVID-19, without leaving home or work. For the first time (with limited state exceptions), we are also covering telephone-only care to support continuity of care for affiliated health plan members during extended periods of social distancing.

Michael Taylor, CareSource

On March 9, 2020, we announced that we would waive all prior authorizations and cost-sharing for any screening and testing for COVID-19. We have expanded our telehealth programs so that they can obtain medical services from their homes. Our web site and social media platforms are continually communicating the most recent health information.

Kate Marx, Humana

Humana has expanded telehealth services quickly and broadly. The company recognizes that both participating/in-network primary care and specialty providers can deliver care using telehealth services, including behavioral health services. For telehealth visits with a specialist, Humana encourages members to work with their primary care physician to facilitate care coordination.

Kim Sonerholm, UnitedHealthcare of Kentucky

UnitedHealthcare expanded access to telehealth can be used for both COVID-19 and non-COVID-19 healthcare needs. UnitedHealthcare waived cost-sharing for in-network, non-COVID-19 telehealth visits for its Medicare Advantage, Medicaid, Individual and Group Market fully insured health plans until June 18. We will work with self-funded customers who want us to implement a similar approach. The company previously announced we would waive cost-sharing for telehealth visits related to COVID-19 testing, in addition to waiving cost-sharing for 24/7 Virtual Visits with preferred telehealth partners.

The Optum Help Line, a free 24/7 emotional support line, is staffed by professionally trained mental health experts. A free on-demand emotional support mobile app called Sanvello, is available to help with stress, anxiety and depression during the pandemic.

Bill Jones, WellCare of Kentucky

WellCare is leveraging the technology we have to offer telehealth services at no cost, so people can speak to doctors or participate in outpatient therapy without leaving the safety of their homes.

In order to make sure that all members can take advantage of telehealth services—and to combat loneliness and isolation—WellCare has long provided free smartphones to Kentucky Medicaid members. Now, WellCare is expanding the limits on both calls and data for those smart phones. The data available to members was raised to 5 GB from 3 GB in April, and unlimited call minutes have been available since April—an increase from the 350 minutes previously offered.

Medical News: Specific to COVID-19, how are you working to help patients and their families facing this virus?

Stephen Friedhoff, MD, Anthem

Anthem has expanded coverage related to COVID-19 testing and treatment for members in our affiliated health plans. We are waiving copays, coinsurance and deductibles for the diagnostic test related to COVID-19, as well as for visits associated with COVID-19 testing, whether the care is received in a physician’s office, an urgent care center or an emergency department. The cost share for COVID-19 treatment will be waived through May 31, 2020. In addition, telehealth and telephone-only visits, including visits for mental health and select physical, occupational and speech therapies, will be available to members at no cost until June 14, 2020.

We are providing post-discharge support to Medicare members with complex care needs who may need additional assistance as they transition back to home following hospitalization.

We have relaxed early prescription refill limits for most maintenance medications to ensure individuals have a sufficient supply of medications that are taken regularly. Our pharmacy benefits manager, IngenioRx, is also carefully monitoring the global drug supply for any disruptions related to COVID-19.

Michael Taylor, CareSource

The experts at CareSource’s 24-hour nurse line are available to answer questions at any time. Members can find the number on the back of their insurance card and on our web site. Our Care Management Team is actively reaching out to our high-risk members encouraging them to utilize telehealth services their Primary Care Providers or essential Medical Specialists offer. If their providers are not available, our Care Management Team can explain how to access other options.

We are available to assist our members with transportation issues if they are experiencing problems getting to appointments for dialysis or chemotherapy treatments. We are working with our members to ensure they have up-to-date information and provide the assistance needed to ensure they receive necessary care.

Kate Marx, Humana

The member-support line with specially-trained call center employees is helping members with four of their primary concerns – managing their health conditions, meeting basic needs (such as access to food), getting their medications and loneliness and social isolation. The stories from this call center are incredibly heartwarming. Here are two that Bruce Broussard, CEO of Humana, shared:

Take Donald for example. Several weeks ago, he fell and needed stitches and went to the ER. Three weeks later, it was time to get the stitches removed — a step that would have normally required a trip to the doctor. But because of COVID-19, Donald’s primary care physician’s office was closed and only accepting virtual appointments. Donald didn’t know where else to go besides the hospital.

That’s when Humana called. Our team worked with Donald to make sure he understood the high risk associated with visiting the hospital and instead helped with a plan to get his stitches removed at home. After speaking to Donald, his Humana care manager realized a nurse lives next door. We arranged a time for his neighbor to safely come to Donald’s home, and we made sure Donald and his neighbor knew how to use telemedicine to contact a doctor in real time in case there were issues removing the stitches. Now, Donald is recovering safely at home and avoided a trip to the ER, helping reduce his risk of getting sick.

When Mary, a Humana At Home care coordinator, was calling members to check on their health and well-being during the COVID-19 pandemic, she connected with Alice, a 75-year-old living alone.

Coronavirus intensified Alice’s existing anxiety and depression, combining with her underlying health issues like COPD, asthma and kidney disease to leave her in a troubling situation. Unable to leave home with just two days of food left, Alice told Mary her gas had been shut off.

Mary moved quickly, identifying and coordinating community resources to help Alice. She connected Alice with her utility provider to get her gas turned back on, and Humana helped her get healthy meals delivered directly to her door. Mary also worked with Alice to ensure she knew about available resources to get food, helping reduce her anxiety. Now, Alice can continue to stay safe at home and has peace of mind knowing she has a reliable source of food.

Kim Sonerholm, UnitedHealthcare of Kentucky

UnitedHealthcare has waived member cost-sharing for the treatment of COVID-19 until May 31, 2020 for Medicare Advantage, Medicaid, Individual and Group Market fully insured health plans. We will also work with self-funded customers who want us to implement a similar approach on their behalf. This builds on the company’s previously announced efforts to waive cost-sharing for COVID-19 testing and the testing-related visit, and the expansion of other member services.

Members who are at high risk may be prescribed self-isolation by their provider. The UnitedHealthcare navigation support program provides a dedicated advocate to guide members through the isolation process.

Bill Jones, WellCare of Kentucky

We have redeployed many of our associates to perform outbound check-in calls with our members that have received a test for COVID-19. For those that have tested positive, we want to make sure they are coping and have the needed resources such as follow-up care and medication in place during this period. We have made over 5,000 outbound calls to our members.

We have eliminated out-of-pocket costs for members—waiving all copays, deductibles, cost-sharing and diagnostic testing fees that may otherwise inhibit clear access to that care. Additionally, we’ve been permitting early refills on most prescriptions, so members can have extra supplies on hand without worrying about lapses in medication. We’ve also been providing access to out-of-network services as needed.

Medical News: How are you supporting the physicians and hospitals on the frontline of this battle?

Stephen Friedhoff, MD, Anthem

We’ve simplified provider protocols to help deliver safe, effective and timely care. Our affiliated health plans have suspended select prior authorization requirements for patient transfers and the use of medical equipment critical to COVID-19 treatment. Additionally, we will cover respiratory services for acute treatment of COVID-19 and provide both in-network and out-of-network coverage for COVID-19 laboratory testing. We are also temporarily adjusting how we monitor claims and audits.

We launched a Medical Associate Volunteer Program, which allows our associates the opportunity to take paid leave from their regular Anthem role and use their medical expertise and training to support care providers in their communities.

Michael Taylor, CareSource

CareSource has enhanced our telehealth and care management programs, communicated this updated information to our members, waived all prior authorizations and cost-sharing for screening and testing for COVID-19; and allowed more flexibility in the payment of their insurance premiums.

In the resolution of their insurance claims, CareSource is reconfiguring our claims systems to accommodate for the rapid changes in diagnosis and CPT codes, treatment methods, credentialing of medical personnel which may not be associated with a particular facility; all to ensure that when claims are submitted, we can process them as quickly as possible.

Kate Marx, Humana

For healthcare providers, Humana simplified and expedited claims processing to get reimbursement payments to providers as quickly as possible and help ease their financial concerns. In addition, the company expanded its policy of suspending prior authorization and referral requirements, instead requesting notification within 24 hours of inpatient (acute and post-acute) and outpatient care. Humana has also expanded telehealth service scope and reimbursement rules. The company is reimbursing for telehealth visits, including audio-only telephone visits, with participating/in-network providers at the same rate as in-office visits.

Kim Sonerholm, UnitedHealthcare of Kentucky

UnitedHealth Group, through UnitedHealthcare and Optum, is providing nearly $2 billion in accelerated payments and financial support to U.S. healthcare providers to address the short-term financial pressure. This will allow our care provider partners to focus on delivering needed care. In addition, OptumHealth will provide up to $125 million in small business loans to its partner clinical operators.

This further streamlines processes such as suspending prior authorization requirements for members transferring to a post-acute care setting or to a new provider; extending filing deadlines for claims under Medicare Advantage, Medicaid, and Individual and Group Market health plans; and implementing provisional credentialing for out-of-network, licensed independent providers to participate in one or more of our networks.

Bill Jones, WellCare of Kentucky

WellCare’s expanded telehealth services protect providers as well as members. WellCare is also committed to reducing administrative burdens on providers by suspending prior authorization requirements until May 31, 2020, in order to increase provider capacity and improve efficiency. As part of WellCare’s efforts to assist non-participating providers who may be treating our members during this public health emergency, we have also streamlined our requirements for provider enrollment.

Additionally, we are performing check runs daily to reduce the lag time between submitting a claim and receiving payment to help improve the cash flow of our providers.


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