Stakeholders across the health care industry are adapting policies and procedures to mitigate, as much as possible, the ongoing impact of the novel coronavirus (COVID-19).
At Fallon Health, we have a long-standing commitment to making it as easy as possible for our members to get the care they need, in the right place and at the right time. While we’ve already modified some of our practices to facilitate members getting care, we’re making a few more changes now, in compliance with yesterday’s bulletin from the Massachusetts Division of Insurance (DOI).
Here are the additional changes that are effective as of April 9, 2020, and will remain in effect during the Massachusetts state of emergency:
- More cost-sharing elimination
- For outpatient coronavirus treatment delivered by in-network providers, we are providing coverage and waiving all cost-sharing (i.e., deductibles, coinsurance and copayments). This includes medically necessary professional, diagnostic or laboratory services provided in accordance with Massachusetts Department of Public Health (DPH) and Centers for Disease Control and Prevention (CDC) guidelines.
- For emergency department and inpatient coronavirus treatment delivered by in-network or out-of-network providers, we are providing coverage and waiving all cost-sharing (i.e., deductibles, coinsurance and copayments). This includes medically necessary professional, diagnostic or laboratory services provided in accordance with DPH and CDC guidelines.
- Removal of prior authorization requirements
- For medically necessary emergency department and inpatient services provided by out-of-network acute-care hospitals, we will not require prior authorization for coverage. This includes professional, diagnostic and laboratory services in accordance with DPH and CDC guidelines.
We’ll apply the same changes to our ASO clients, unless they contact us to opt out of the change by April 15, 2020.
Please contact your Account Manager if you have questions about these changes.
