March 09, 2020
Area(s) of Interest: Public Health Practice Management
On March 5, California Governor Gavin Newsom issued a directive requiring health insurance companies to waive member cost-sharing amounts for screening and testing for the COVID-19 disease. Both the California Department of Insurance and the California Department of Managed Health Care notified payors that they must immediately eliminate cost-sharing, including but not limited to co-pays, deductibles and coinsurance for medically necessary screening and testing for COVID-19 and associated hospital, emergency department, urgent care and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.
Physician practices should be aware that they are not to collect any patient cost-sharing for COVID-19 related testing and screening. Payors should be reimbursing physicians at their full contracted rates for these services, as they would for other preventive services. If payors do not reimburse in full, physicians should submit an appeal to the payor and also notify the California Medical Association so we can monitor the situation.
In the wake of the announcement, payors have begun issuing notices instituting the required changes to patient cost sharing. The notices are linked below, and we will update the list as additional notices are issued: