Gov. Jared Polis on Monday directed the Colorado Division of Insurance to issue orders related to the costs of testing and prescription refills tied to the outbreak of novel coronavirus, or COVID-19.
Those orders require insurers to waive co-pays, deductibles or coinsurance for telehealth visits or other medical visits tied to testing for the virus, which has sickened nine in Colorado, with a new "presumed positive" case announced Monday.
The waivers apply to visits to a doctor's office, an in-network urgent care center, or an emergency room. If an in-network provider is unable to do the testing, the insurance carrier must cover it is provided by an out-of-network provider, the bulletin said.
The bulletin also outlines just who's going to get tested:
- Those with a fever or symptoms of a lower respiratory illness, such as a cough or shortness of breath, and the patient has been in close contact with someone who has tested positive for COVID-19, within 14 days of when symptoms started.
- A person who has traveled to somewhere in the world where COVID-19 infection rates are high, shows symptoms such as a fever or a lower respiratory illness and where the flu has been ruled out; also within the 14-day window; and
- A person with a severe acute respiratory illness, such as pneumonia, that requires hospitalization and where the flu has been ruled out.
The bulletin issued Monday by the division also directs health plans to remind members about telehealth options.
On prescription refills, the division is ordering insurance providers to cover an additional one-time early refill of any "necessary prescription," should patients want to limit close contact with others. However, the bulletin does not define "necessary" prescriptions. The bulletin, however, does say that it does not apply to prescription drugs with "a high likelihood of abuse, such as opioids."
Spokesman Vincent Plymel said the length of the prescription refill is up to the provider.
The federal government has recently announced that testing for the virus, which is now active in 28 states, is considered an "Essential Health Benefit," which means it must be covered by health care insurance providers and without copays, deductibles or coinsurance.
“Our administration is taking swift action to ensure Coloradans can get tested for COVID-19 without financial fear,” Polis said in a statement Monday. “This important step will help ensure cost barriers do not stand in the way of people getting tested. The earlier that we can diagnose and isolate those testing positive for COVID-19, the better we can prevent it from spreading.”
The orders apply only to insurance providers regulated by the Division of Insurance, so it does not apply to self-funded employer-based health plans or other plans regulated at the federal level. Coloradans covered under those plans should contact their employers.