Washington Orders No Deductibles, Co-pays for Coronavirus Visits and Testing on Some Health Plans

Mar. 5–Editor's note: An earlier version of this story contained incorrect information on the scope of the order. It has been corrected and updated.

Washington's insurance commissioner issued an emergency order Thursday directing health insurance carriers with state-regulated plans, through May 4, to provide health care provider visits and novel coronavirus testing without co-payments and deductible payments to enrollees and who meet criteria for testing.

The order will apply to individual-market plans, as well as small-group and large-group employer plans, which cover about 1.2 million people, but not to self-funded employer plans, Medicaid and Medicare, which are regulated by the federal government, Insurance Commissioner Mike Kreidler's office said.

Many major employers have self-funded plans, including Microsoft, Amazon, Boeing, the city of Seattle and King County, the office said. For such plans, employers cover claims rather than paying premiums to insurance carriers.

Additionally, Gov. Jay Inslee said Thursday that the state will help pay for coronavirus tests for people who lack health insurance. He didn't immediately share details about how that may work.

“I am announcing that we have the authority and intention to cover those costs by the state of Washington,” Inslee said. There is still a limited supply of testing kits, he said, so people should consult with their doctor about whether a test is necessary.

https://twitter.com/VestaRose/status/1235770559939698690

“If you think you're experiencing mild symptoms, a positive or negative test result does not change the advice we have for you,” said Inslee. “Stay home, rest, take care of yourself, avoid contact with others and follow your physician's or medical provider's advice.”

“This is a period of substantial anxiety in our state, it's real, it's significant, and we need to recognize it,” he added.

Questions about coronavirus testing and treatment costs have stirred some concern about people without insurance, as well as insured people without extra money for surprise medical bills. People anxious about costs may delay care and thereby contribute to the spread of the virus, public health experts have said.

Washington now has 70 confirmed cases of coronavirus, including 51 in King County (with nine deaths), Washington State Department of Health (DOH) Secretary John Wiesman said Thursday. DOH hasn't been charging for tests at its laboratory in Shoreline.

“Consumers are rightly concerned about prevention, testing and possible treatment,” said Kreidler, the insurance commissioner. “My emergency order provides guidance to health insurers and should help reassure the public that we will take all necessary steps to protect them.”

Kreidler's order, issued with authority from the state of emergency declared by Inslee on Feb. 29, directs Washington-regulated health plan insurers to cover “prior to application of any deductible and with no cost-sharing, the health care provider visit and … testing” for enrollees who meet federal criteria for COVID-19 testing, as determined by their health care providers. New York state took a similar step earlier this week.

Washington's order also directs insurance carriers to allow enrollees “to obtain a one-time refill of their covered prescription medications prior to the expiration of the waiting period between refills.” The point of that directive is to make sure people “can maintain an adequate supply of necessary medication” amid the disruptions caused by the coronavirus outbreak.

“Carriers may take into consideration patient safety risks associated with early refills for certain drug classes, such as opioids, benzodiazepines and stimulants,” the order says.

Thirdly, Kreidler's order directs insurance carriers to “suspend any prior authorization requirements that apply to covered diagnostic testing and treatment” of the novel coronavirus. That means patients shouldn't need insurers to sign off on testing and treatment beforehand.

Lastly, the order says a carrier with an insufficient number or type of in-network health care providers to provide coronavirus testing and treatment must ensure that an enrollee can obtain testing and treatment from an out-of-network provider “within a reasonable proximity … at no greater cost than if the provider were in-network.”

“The outbreak of the novel coronavirus in Washington state requires swift and coordinated action across the public and private sectors to minimize human suffering,” Kreidler's order says.

Seattle City Councilmember Kshama Sawant on Monday urged Mayor Jenny Durkan and King County Executive Dow Constantine to use emergency funds “to guarantee that anyone in our region with a respiratory illness has access to a doctor's visit without fear of medical bills.”

People without insurance should consider seeking care at public-health centers and neighborhood clinics, public health officials have said. They also should check with the Washington Health Benefit Exchange to determine whether they may qualify for Medicaid or Medicare.

The Wall Street Journal reported Tuesday that the Trump administration was considering using a national disaster program to pay for the care of uninsured people with coronavirus.

Inslee also said Thursday the state Department of Labor and Industries will provide workers' compensation benefits to first responders and healthcare employees who are quarantined after being exposed to the coronavirus on the job. The benefits will include coverage for treatment expenses, medical testing and loss-time payments for those who can't work.

“We should have their backs, it's the right thing to do,” Inslee said.

Daniel Beekman: 206-464-2164 or [email protected]; on Twitter: @dbeekman. Seattle Times staff reporter Daniel Beekman covers Seattle city government and local politics.

Joseph O'Sullivan: 360-236-8268 or [email protected]; on Twitter: @OlympiaJoe. Seattle Times staff reporter Joseph O'Sullivan covers state government and the Legislature.

___

(c)2020 The Seattle Times

Visit The Seattle Times at www.seattletimes.com

Distributed by Tribune Content Agency, LLC.