Is Your Company’s Health Insurance Treating You Correctly During COVID?
While most health insurance companies are stepping up during this COVID Pandemic, a few insurances may not be. I’ve dealt with health insurance since I was diagnosed with my arthritis and autoimmune disorder in 1998. So, my friends know that if they have trouble with health insurance, Itry to be the go-to person.
My friend’s husband works for a company in her local town. So, she can’t directly deal with the insurance herself. She has to depend on her husband to deal with the issues that pop up that she can’t handle via the insurance phone number herself. That is hard. I’ll get to that.
Here’s the problem. This company has an outbreak of COVID within their facilities. According to my friend (hearsay), that part of the company is being deep cleaned. Although, the rest of the company is continuing to work. That includes her husband. It’s known within the community that the company employee are testing positive. I’m sure it is really hard to keep that secret.
Her husband’s company belongs to insurance that has several other companies combined. Her husband’s company is the ONLY one within that group that denies telehealth and virtual medicine. That has been confirmed through phone calls by her and her physician.
My friend and her husband pay the top of the line of insurance and have had 4 bills denied so far before they found out that these were being denied. So, they owe over $400 out of pocket already because they didn’t know the rules. They accepted that situation.
Now, though, health providers don’t want the couple to come inside for visits. They feel they have been in contact with COVID, so they think that telehealth or virtual med would be better. Their insurance will NOT pay that. Needed health visits are being canceled.
- What I advised her to do:
- Her husband deal with company HR
- Call company HR herself
- Call the main company that owns the facility
- Call the other company that has holdings with the company
- Calling the Arkansas Attorney General
- Calling Arkansas Insurance Commission (per Arkansas Attorney General’s advice)
While Arkansas has set some rules regarding COVID coverage, you are kind of screwed if you have “company insurance”. This is what I found on what the Governor has released:
Status as of April 24, 2020
Existing state telehealth coverage mandate?
YES for all policies offered by commercial insurers, self-funded government and church plans and Medicaid programs; includes reimbursement parity required only for physician services; insurers have the discretion to cover audio-only phone, email or text messaging
Ark. Code §§ 23-79-1601, 1602
Emergency state action on coverage of telehealth services?
Executive Order 20-05 dated 3/13/20 suspends the provisions of the Telemedicine Act under Ark. Code Ann. 17-80-401, et seq. and waives the initial in-person or face-to-face examination via audio-video conferencing to establish a professional relationship in order to diagnose or treat a patient via telehealth.
It should be noted that the Arkansas Department of Health has temporarily suspended certain regulations to expand the definition of “physician” to include psychologists per Executive Order No. 20-06.
Guidance by the Board of Psychology states: For 120 days from 3/20/2020, licensees will not be required to submit a new Statement of Intent (SOI) to practice Telepsychology in Arkansas. Licensees must comply with APA Telepsychology Guidelines; Arkansas Telemedicine Act, HIPAA, and any other rules, statutes, or orders pursuant to the practice of psychology.
Emergency state action on telehealth reimbursement parity?
CMS Section 1135 Medicaid Waiver approved 4/2/20 allows for reimbursement of payable claims by out of state-licensed providers not enrolled in the state Medicaid program subject to certain conditions for the duration of the public health emergency.**
Department of Insurance Bulletin No. 13-2020 dated 3/27/20 directs all health insurance carriers (including short-term limited-duration plans) to comply with the telehealth reimbursement parity requirements specified in Ark. Code. Ann. § 23-79-1602(c), (d).
Emergency state action to include audio-only phone?
Executive Order 20-05 temporarily allows the audio-only phone to provide telehealth services.
Supervised Trainee Telehealth Services – Telesupervision and Medicaid Reimbursement
Psychology Interns are not included as eligible providers as part of the emergency rule released by the Arkansas Board of Psychology: “All Providers providing care via Telepsychology to a patient/client located within the State of Arkansas shall be licensed to practice psychology in the State of Arkansas.”
Her husband’s company has yearly sales revenue of $514 million. That is one section of the company. Why not pay for telehealth, why not pay for virtual health? Although some insurances have set forth plans to address COVID– my friend’s insurance is not listed.
I highly suggest that you start from the bottom to the top when it comes to any problem. This particular problem may not get solved. Corporate greed usually wins out over employee health and safety. I’m not an expert in dealing with insurance and truly NO EXPERT in dealing with COVID. I just want to give you some suggestions on where to start when it comes to insurance problems.
How is your insurance treating you during this pandemic?