Last updated on 5/27/20
Have a question about COVID-19? We’re here to help.
Will AmeriHealth Administrators cover testing for COVID-19?
AmeriHealth Administrators will cover and may reimburse plan member cost-sharing (such as co-pays, deductibles, and coinsurance) for the COVID-19 test and the administration of the test when performed at a physician’s office, urgent care center, or an emergency room. Treatment for COVID-19 is subject to the specific out-of-pocket cost-sharing for each plan member’s health benefits plan. For services not related to COVID-19, we will continue to apply the appropriate member cost-sharing. In addition, IRS guidance, released March 11, allows for testing and treatment services before the deductible is met for plan members with high-deductible health plans and health savings accounts (HSAs).
Given that the test is new and specific billing codes for commercially available tests were only recently designated, plan members should report any concerns about claim payment to our customer service staff at the number on their member card. At this time, the Centers for Disease Control and Prevention (CDC) and state labs currently performing the testing are not billing for COVID-19 testing, so plan members should not incur costs when tested by these labs.
If plan members have any questions about whether they should be tested, they should contact a health care professional who will work with the state public health department in the member’s state and the CDC to determine if they need to be tested for COVID-19.
What about treatment?
At this time, there is no specific antiviral treatment or vaccine for COVID-19. Plan members should receive care from their doctor to help relieve symptoms as they would other viral respiratory infections. AmeriHealth Administrators continues to cover medically necessary health care costs to treat infectious diseases, including COVID-19, based on the terms of the plan member’s health benefits plan.
AmeriHealth Administrators has temporarily suspended prior authorizations for acute inpatient admissions from an emergency department at all in-network facilities for members with a COVID-19 diagnosis through July 31, 2020. In addition, prior authorization requirements are temporarily suspended for transfers from acute in-network inpatient facilities to post-acute in-network facilities (long-term acute care hospitals, rehabilitation or skilled nursing facilities) for any diagnoses. Notification from facilities is still required.
This includes suspending prior authorization requirements for in-network transportation from an acute inpatient facility to a post-acute facility.
These steps are intended to facilitate and reduce administrative processes for the placement of COVID-19 patients to the most appropriate care settings.
If plan members would like information about specific symptoms they are experiencing or have questions about their personal health, we recommend that they contact their doctor. For reliable information about the coronavirus disease (COVID-19), we suggest visiting the CDC website at cdc.gov/coronavirus.
We will continue to evaluate plan member needs as the situation changes.
How can plan members find a testing location?
If you suspect that you may have COVID-19, your first step should be to contact your primary doctor. Your primary doctor will screen you for testing based on CDC guidelines. If you meet the testing criteria, your doctor will discuss your testing options with you. If you don’t have a primary doctor, plan members with telemedicine benefits can utilize MDLive services for free until December 31, 2020*. An MDLive physician can perform the screening and determine your next steps. Please review the terms of your health benefits plan for additional information. You can register for MDLive at myahabenefits.com. If your health benefits plan does not include telemedicine benefits, you can contact your state health department for information on testing. Pennsylvania residents can call 1-877-PA-HEALTH. New Jersey residents can contact the NJ Department of Health for more information at 1-800-962-1253 or 1-800-222-1222. Minnesota residents can contact the MN Department of Health for more information at 1-888-345-0823.
Should plan members be using telemedicine?
To help reduce potential exposure, AmeriHealth Administrators encourages plan members to utilize telemedicine services if they are available as part of a plan member’s health benefits plan.
Plan members who don’t have telemedicine services included in their health benefits plan should ask their primary care doctor or specialist to see if they can conduct a visit by phone or video chat.
AmeriHealth Administrators announced on March 6 that it may waive copays for primary care telemedicine services for eligible plan members through December 31, 2020*. On March 20, AmeriHealth Administrators expanded telemedicine services for specialty and ancillary services subject to applicable plan member cost sharing. This expansion includes:
- Specialist visits (via video or telephone)
- Physical therapy, occupational therapy, and speech therapy visits (via video)
- Urgent care visits (via video or telephone)
- Nutritionist visits (via video or telephone)
- Behavioral health visits to include plan members with autism spectrum disorder so that they can receive Applied Behavior Analysis support while they are at home.
As noted, regular cost-sharing will apply to telemedicine visits with specialists and ancillary providers that are not related to COVID-19 testing. Cost-sharing may be waived for COVID-19 testing and primary care telemedicine visits for high-deductible health plan members and may be covered before deductible.
All changes will be in effect through December 31, 2020. To access telemedicine options, AmeriHealth Administrators plan members should log in to the member website at myahabenefits.com.
Are telemedicine visits with non-participating providers covered for plan members with out-of-network coverage?
Given AmeriHealth Administrators’ broad network, it is unlikely that a plan member would need to seek care from an out-of-network provider.
However, telemedicine visits with non-participating providers are covered for plan members with out-of-network coverage and are subject to the out-of-network cost-sharing under the plan member’s benefit plan. This applies to specialists as well as behavioral health providers.
Will AmeriHealth Administrators waive prescription drug refill limits?
AmeriHealth Administrators has lifted prescription refill restrictions, such as the “refill too soon” for all plan members with AmeriHealth Administrators pharmacy benefits. We also encourage plan members to use their 90-day mail order benefit. Plan members who don’t have a 90-day prescription are encouraged to talk with their doctor to see if that option makes sense for them. In the case of medication shortages or access issues, AmeriHealth Administrators plan members will not be responsible for additional charges that stem from obtaining a non-preferred medication if the preferred medication is not available.
We are carefully monitoring COVID-19 developments and will make adjustments to policies as appropriate. We recommend that plan members call the Pharmacy Services number on their ID cards as needed if they require additional medication refills due to a potential quarantine situation.
Will AmeriHealth Administrators cover hospital quarantine stays for plan members returning from travel to affected countries?
Plan members who are in a healthcare facility and or quarantined in their home will have medically necessary services covered under the terms of their health benefits plan.
How is AmeriHealth Administrators communicating with its employees about COVID-19? How is AmeriHealth Administrators working to keep its workforce safe?
AmeriHealth Administrators remains steadfast in the aim to reduce the impact of COVID-19 on our workforce, our plan members, our customers, and our business. We communicate regularly with our associates and have taken several steps to safeguard their health.
On Tuesday, March 17, AmeriHealth Administrators announced that that the company will close all offices in the Philadelphia area, New Jersey, and Minnesota, effective March 18, until further notice. All employees in all offices will be required to work remotely during that time to reduce the risk of illness through person-to-person contact. Prior to this, Independence “stress-tested” technology by asking certain departments to work from home on March 2, and then offering the option company-wide on March 10.
How is AmeriHealth Administrators working with, and communicating with, providers related to COVID-19?
AmeriHealth Administrators is fortunate to have strong relationships with the providers, hospitals and health systems that provide care for our plan members. Our executives are staying in close contact with leaders within the provider community to monitor this rapidly changing situation and make the most appropriate decisions to help maintain the health and wellness of people in the communities we serve.
We have also been communicating the latest news and information about COVID-19 to providers through our existing communication channels.
How is AmeriHealth Administrators working with elected officials related to COVID-19 planning and prevention?
AmeriHealth Administrators is collaborating with public health organizations and elected officials at the regional, state and federal levels. Our executives are staying in close contact with leaders at all levels to monitor this rapidly changing situation and make the most appropriate decisions to help maintain the health and wellness of people in the communities we serve.
If plan members, employers, or brokers want more information about COVID-19, where should they go?
If plan members, employers, or brokers would like information about specific symptoms they are experiencing or have questions about their personal health, we recommend that they contact their doctor.
For reliable information about the coronavirus disease (COVID-19), we suggest visiting the Centers for Disease Control and Prevention (CDC) website at cdc.gov/coronavirus. The City of Philadelphia, Commonwealth of Pennsylvania, and the Minnesota Department of Health have also established websites with information about COVID-19.
AmeriHealth Administrators launched a comprehensive website dedicated to COVID-19 information and resources at ahatpa.com/covid-19. As well, we will continue to update our Newsroom with the latest information about COVID-19, and we will continue to proactively communicate with our key stakeholders through our existing channels, as needed.
How can members protect themselves against fraud?
Unfortunately, AmeriHealth Administrators has received some reports of potential frauds and scams related to the COVID-19 situation. Members should be aware of individuals attempting to profit from this emergency and should remain diligent in protecting personal and health insurance information. Some of the reports we have received include:
- Individuals and businesses selling fake tests, treatments and cures for COVID-19 online.
- Phishing emails from entities posing as trusted organizations like the World Health Organization or the Centers for Disease Control and Prevention.
- Know the vendor you’re buying from. Online sellers may falsely claim to have in-demand products like cleaning, household, and health and medical supplies.
- Unsolicited calls, e-mails or home visits from individuals offering free services or supplies in exchange for member numbers.
Members can help to avoid fraud by following these tips:
- Reviewing medical claims submitted at myahabenefits.com for accuracy.
- Protecting their insurance card.
- Protect your identity. Do not provide your Social Security Number.
- Declining to provide insurance information to anyone that is not directly providing care to a member.
- Being cautious of unsolicited telemarketers and recruiters.
If members suspect that something potentially fraudulent has occurred with respect to their Independence Blue Cross health insurance, they should contact Independence. All reports can be submitted anonymously.
Here are three options for submitting a report:
- Submit the Online Fraud & Abuse Tip Referral Form electronically at ibx.com/antifraud.
- Call the confidential anti-fraud and corporate compliance toll free hotline at 1-866-282-2707 / TTY# 888-789-0429.
- Mail the report. Write a description of your complaint, enclose copies of any supporting documentation, and mail it to Independence Blue Cross, Corporate & Financial Investigations Department at 1901 Market Street, 42nd Floor, Philadelphia, PA 19103.
Additional resources include:
- City of Philadelphia Information and Recommendations
- Minnesota Department of Health
- How to prepare: Managing anxiety and stress
- Greater Philadelphia Coronavirus Helpline 1-800-722-7112 (launched by the Philadelphia Department of Public Health and supported by the Children’s Hospital of Philadelphia)
- COVID-19 helpline for Minnesota residents: 1-800-657-3903 (Minnesota Department of Public Health)
- Feeling stressed about COVID-19? Tips from Magellan Health
- What to do if you are sick with COVID-19 or caring for someone with COVID-19 (Centers for Disease Control and Prevention – CDC)
*The Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act mandate that member cost sharing (deductible, co-pays and coinsurance) is waived both in and out-of-network for the testing and diagnosis of COVID-19 through the public health emergency. If the public health emergency ends prior to December 31, 2020, the waiver of cost sharing for out-of-network testing and diagnosis will end as of the date the public health emergency ends. If the public health emergency does not end as of December 31, 2020, the waiver of member cost sharing for both in and out of network will continue through the public health emergency. For High Deductible Health Plans, in-network cost sharing waivers detailed above will remain in effect through December 31, 2020 unless prohibited by law.