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Coverage for Covid-19 Testing and Treatment

Are there any prior authorizations required for COVID-19 treatment – and if so, will they be waived?

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Blue Shield will not require prior authorization or cost-sharing for medically necessary COVID-19 testing and related screening, including a related hospital, office, emergency room, or urgent care visit, in accordance with state and federal requirements.

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How much do tests and test kits cost?

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Blue Shield of California is waiving the need for prior approval and all cost-sharing for COVID-19 testing prescribed by a physician and administered by a health care professional for all members enrolled in Blue Shield’s fully insured commercial and Medi-Cal plans. Until recently, COVID-19 testing was only available from the CDC and was free. Private labs are now beginning to provide testing when ordered by a physician.

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Are at-home Coronavirus test kits covered by Blue Shield and will the copay be waived?

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At this time, Blue Shield and Blue Shield Promise will only cover self-administered test kits that are FDA-approved, or emergency use authorized, or authorized under other guidance from the Secretary of the Department of Health and Human Services consistent with the federal CARES Act. Other self-administered tests available on in the market are not covered.

Blue Shield and Blue Shield Promise require self-administered tests be ordered by a healthcare provider, sent to the approved laboratory specified on the kit, and processed in accordance with FDA and other guidance, as applicable. This policy is in accordance with applicable legislation, including the federal CARES Act.

Blue Shield and Blue Shield Promise will not cover self-administered test kits that fail to meet the conditions specified above. Members should call the phone number on the back of their member ID card to confirm coverage.

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Do benefits and coverage plan documents [such as Summary of Benefits and Coverage (SBC), Summary of Benefits (SOB), Evidence of Coverage (EOC) documents or contracts] require any amendment or update?

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Blue Shield of California typically does not update Summary of Benefits and Coverage (SBC), Summary of Benefits (SOB), Evidence of Coverage (EOC) documents or contracts for a specific disease. However, they will evaluate the impact to contracts with direction from state regulators and Blue Shield of California’s mandates team.

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When did Blue Shield start to process claims with no cost-sharing for COVID-19-related services?

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On March 18, 2020, Blue Shield began processing member co-pays, coinsurance, and deductibles at no cost. Any claims received between January 27 and March 18 will be readjudicated at zero dollars for COVID-19-related testing and screening services in accordance with state and federal law.

On April 1, 2020, Blue Shield announced it would also waive member co-payments, coinsurance, and deductibles for treatment, effective March 1 through May 31 for fully insured plans.

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If a member pays for the co-payment, either through an office visit or Teladoc, because the provider requested payment at time of service, will they be reimbursed?

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If a member is improperly charged for a co-payment, the member should call the number on the back of their member ID card and Customer Care will work with them to get a reimbursement issued.

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If a member becomes infected while traveling abroad, would this qualify for emergency/international coverage under their Blue Shield plan?

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Under the global care provisions of their plan, Blue Shield of California members are provided emergency medical assistance when traveling out of the country, This includes telephonic support, finding a provider, and assistance with subsequent claim payments. Should a member become infected with COVID-19, they would qualify for emergency international coverage. The approval for any coverage is subject to their covered benefits. (i.e. repatriation is not a covered expense).

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Is Blue Shield of California covering the cost of testing and treatment for COVID-19?

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Yes. Blue Shield is waiving out-of-pocket costs for co-payments, coinsurance, and deductibles
for COVID-19 testing and treatment through September 30, 2020.

Learn more.