Who pays for COVID-19 diagnostic testing/treatment if needed?
Group Health Plans, Self-Insured (Self-Funded) Plans and Individual or Group Coverage through the Marketplace
Lab Testing: The federal Centers for Disease Control and Prevention (CDC) and the Pennsylvania Department of Health are covering the cost of the lab test for the presence of COVID-19 performed in federal or state labs when certain conditions are met. Click here to visit the PA Department of Health's website for more information. In order to help combat the spread of the virus, testing in commercial labs has also become available. Contact your insurance company to make sure your lab is in-network or check to see what provisions the insurer has put in place for out-of-network lab work. Hospitals and providers are expected to bill insurance companies for the fees associated with collecting the specimens, and labs are expected to bill for the actual testing. If the test is recommended by your doctor or other health care provider, the Families First Coronavirus Response Act requires coverage for the order of and administration of the test with no cost-sharing and no prior authorization or other medical management requirements for provider visits (office, urgent care, ER) including telehealth/telemedicine.
Treatment Coverage Includes: These comprehensive health insurance plans typically provide health coverage for medically necessary treatment. Be sure to check with your insurance provider to understand how your coverage and cost sharing will apply. Also check your health insurance company's network list of providers and hospitals, and, if possible, try to go to a hospital that is considered in-network by your health insurance plan. Some health plans do not provide coverage for out-of-network care, although exceptions can be made in unique circumstances including emergencies.
If you are admitted into a hospital for monitoring and observation your co-payments, co-insurance, and deductiblesmay apply.
Telehealth Coverage: Most insurers cover telehealth for both medical (sometimes called telemedicine) and behavioral health services. Check with your insurer to determine if co-pays, co-insurance, and deductible apply for COVID-19 treatment.
On March 10th, 2020 the Pennsylvania Insurance Department released a Bulletin notice regarding COVID-19 insurance coverage. Click here to view. In the notice, the Insurance Department discusses telehealth delivery of services. It states:
Telehealth Delivery of Services. Given that COVID-19 is a communicable disease, some insureds may prefer to use telehealth services instead of in-person health care services. Health insurers are encouraged to review their respective participating telehealth service provider arrangements, provide coverage of costs related to telehealth services and to be prepared to meet any increased demand for that means of delivery.