The coronavirus pandemic has taken a severe toll on Pennsylvania.
About 1.5 million residents have filed for unemployment assistance in the last five weeks. More than 37,000 people have fallen ill with COVID-19. Without a doubt, there is overlap among those groups.
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The crisis has placed health insurers in a particularly vital role, as many Pennsylvanians are not only fearing the coronavirus but the medical bills that may accompany it.
Independence Blue Cross, the largest health care insurer in Southeastern Pennsylvania, has waived many COVID-19 treatment costs and is covering all diagnostic tests. The company also is helping members navigate tax credits and coverage options that may lower their monthly premiums.
Chief Executive Officer Dan Hilferty recently responded to a series of questions from PhillyVoice, touching on the role of health insurers, the pandemic's impact on future premiums and coverage of serology tests, among other topics.
Here are his responses:
PhillyVoice: What's the best role for health insurers to be playing during this crisis? How has that role shifted in the last several months?
Dan Hilferty: Independence is the leading insurer in our region and this role is even more important during the pandemic. We are working closely with state and regional officials, in addition to the leadership of our health systems in Southeastern Pennsylvania. All the key players put competition aside to defeat our common adversary.
Our mission remains unchanged in this crisis: to enhance the health and well-being of the people and the communities we serve. We are there for those we serve in their most challenging times, as we have been for more than 80 years.
Access to timely and accurate information is critical. We are putting resources at the fingertips of our members to ensure they have what they need to weather the storm. This includes a public awareness campaign about how to reduce the spread of COVID-19.
Independence’s role as a community leader is also important during the pandemic. Through our support of the PHL COVID-19 Fund, and the American Red Cross, we are helping the organizations on the front lines of serving those in need. And we introduced virtual and remote volunteer opportunities so our active Blue Crew associate volunteer group can continue to serve our region’s nonprofits from home.
'We know the toll'
PV: What kind of claims volume is Independence Blue Cross seeing related to COVID-19? How many diagnostic test claims have come through?
DH: We are closely monitoring this. With our first cases in the region just last month, we don’t yet have a full picture.
PV: Millions of Americans are now unemployed – many losing employer-based health insurance in the process. With such a sudden loss of customers and a surge in health care costs from the COVID-19 pandemic, what impact do you expect this all to have on future premiums?
"Testing is critical to containing this pandemic, and all necessary testing needs to be available to whoever needs it." – Dan Hilferty, CEO, Independence Blue Cross
DH: As this situation is still relatively new and we are unsure what the next few weeks and months may hold, it is difficult at this time to assess the financial impacts of COVID-19. As always, we will work with our members, our customers, and all public and private stakeholders to ensure affordable, accessible, high-quality health care.
PV: What options does IBX offer to people who lose their insurance and need to use special enrollment?
DH: We know the toll this pandemic is taking on families and individuals. People who lose employer health insurance may be eligible for a special enrollment period through the Affordable Care Act, as well as tax credits from the federal government to help lower their premiums. If someone already has a plan through the ACA Marketplace, they may be eligible for increased tax credits or to change plans, to help lower their monthly premium. We can help our members evaluate their options or to see if they may qualify for financial assistance. They can call us at 1-800-503-1253.
For those having difficulty making their premium payments but not eligible for financial assistance through the ACA, we are offering some additional options. We encourage members to call us on the number on the back of their card to discuss their concerns.
Covering the costs
PV: IBX has waived cost-sharing for in-network, inpatient acute care treatment for COVID-19, in addition to covering the costs for diagnostic testing. What factored into the decision to waive these costs? Was there concern that people would avoid seeking treatment due to the potential costs involved?
DH: First and foremost, our goal is to ensure that our members get the testing and care they need, for COVID-19 and every other health challenge they face. We are taking several steps to make sure members have access to care during the pandemic. This includes:
• COVID-19 testing for members with no cost-sharing
• Coverage of inpatient COVID-19 treatment with no cost-sharing
• Telehealth visits with members’ existing primary care doctor for any reason, with no co-pay
• Coverage of specialist telemedicine visits and visits with therapists
• Lifting of prescription “refill too soon” restrictions
• Relaxing prior authorization rules for acute inpatient admissions at an in-network facility from an emergency department, as well as transfers to other acute in-network inpatient hospitals and in-network post-acute facilities
We know that the pandemic is affecting not only people’s physical health, but their mental health as well. We are offering our members enhanced emotional support resources, including telebehavioral health, stress reduction and help with sleep problems, and cognitive behavioral therapy.
We have also offered some members a resource kit from Quil Health, the digital health company we created with Comcast. And members now have two months of free access to an online meditation and mindfulness resource called “Breathe, Stop and Think.”
PV: Will serology tests, which have been hyped as a critical tool for reopening society, be covered under most members' plans?
DH: Testing is critical to containing this pandemic, and all necessary testing needs to be available to whoever needs it. In the early stages of the pandemic, we quickly announced we will cover testing for active COVID-19 (RT-PCR) at no cost to our members. Independence will also cover COVID-19 antibody testing with no member cost share in accordance with federal guidelines and company medical policy for the duration of the COVID-19 pandemic.
PV: Many elective surgeries and procedures are being postponed due to the crisis. How long do pre-approvals for such procedures generally last? And will people eventually need to get re-approved for procedures postponed by the crisis?
DH: Canceling elective medical procedures has been key for health systems to free up capacity during this situation. But we know that this change may pose some hardships for our members, so we extended pre-certifications on these procedures for six months.
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