Gov. Jared Polis’ administration is directing Colorado health insurers regulated by the state to waive co-pays, deductibles and other charges for anyone who visits a doctor, urgent care center or hospital to seek a coronavirus test in what is one of the state’s first executive actions to date in response to the outbreak.
But the directive, issued Monday by the Colorado Division of Insurance, applies only to about a third of all insured people in Colorado and would not be in effect if a person doesn’t meet the state’s criteria for testing.
The division, for instance, does not regulate plans that are provided by large employers that are self-insured, meaning the company — not an insurance company — pays employee medical expenses.
If someone visits a medical provider hoping to be tested for coronavirus but does not meet the criteria, a co-pay would still apply. Because of the state’s limited testing capacity, not everyone will get a coronavirus test if they request one.
The Colorado Department of Public Health and Environment’s current criteria dictates patients must fit into the following categories to be tested:
- The patient has a fever and/or signs and symptoms of lower respiratory illness, such as cough or shortness of breath. And the patient also has been in close contact with someone confirmed with COVID-19, within 14 days of when their symptoms started.
- The patient has a fever and/or signs and symptoms of lower respiratory illness and other diagnoses such as influenza have been ruled out. Additionally, the patient recently traveled to parts of the world where coronavirus infection rates are high or community spread is occurring within 14 days of when their symptoms started.
- The patient has a severe acute respiratory illness (such as pneumonia) requiring hospitalization and there is no other explanation, such as a flu diagnosis, for the symptoms.
If an insurance company’s in-network provider doesn’t offer coronavirus testing, the insurer is directed to cover that service.
Coronavirus testing in Colorado is handled by the state lab and is already free. But what’s costly is the corresponding visit to a doctor, urgent care or hospital for care.
A woman who went to an emergency room seeking care for coronavirus-like symptoms told The Denver Post she left with an influenza diagnosis and a $4,500 bill. It was determined that she didn’t require COVID-19 testing.
The directive also requires insurance carriers regulated by the state to conduct an outreach and education campaign to remind people of their telehealth coverage options. In addition, the Colorado Division of Insurance is directing carriers to offer telehealth services covering COVID-19 without coinsurance and co-pay charges that would normally apply to a telehealth visit.
The directive also tells insurance companies to cover the cost of an additional, one-time early refill of any necessary prescriptions to ensure people have access to their medications should they need to limit close contact with others.
“We will be following up with … emergency regulations later this week to formalize these directives,” said Vincent Plymell, Colorado’s assistant insurance commissioner.
There are nine confirmed cases of coronavirus in Colorado. Another case, a woman in her 20s who recently visited Aspen, was diagnosed after the woman returned home to Australia last week.