UHC Reduces Administrative Requirements, Offers Special Enrollment in Response to COVID-19

March 2020 ~

UnitedHealthcare (UHC) has announced several recent updates in response to the Novel Coronavirus (COVID-19) national emergency.

In a recent press release, the insurer stated that, in addition to the previously announced telehealth and virtual care expansion, UHC is further easing administrative requirements and will open a special enrollment period for some of its existing commercial customers to enable people easier access to care.

Special Enrollment Period

For fully-insured and level-funded customers, UHC is easing contractual requirements to offer a special COVID-19 enrollment opportunity that will allow employees who did not opt-in during the regular enrollment period to obtain coverage.

The enrollment period will be open from March 23, 2020, to April 6, 2020.

 Reduced Prior Authorization Requirements

In an effort to reduce administrative burden and ease access to care, UHC has adopted the following measures:

  • Suspension of prior authorization requirements to a post-acute care setting through May 31, 2020; and
  • Suspension of prior authorization requirements when a member transfers to a new provider through May 31, 2020.

The insurer states it will temporarily suspend or relax additional policies as needed in regions where inpatient capacity is most compromised and most at risk.

 Access to Testing and Medical Care 

UHC will waive cost-sharing for COVID-19 testing provided at approved locations in accordance with the CDC guidelines. The insurer is also waiving cost-sharing for COVID-19 testing related visits, whether the care is received in a physician’s office, a telehealth visit, an urgent care center or an emergency department. This coverage applies to commercial, Medicare Advantage and Medicaid members.

  • Designated Telehealth Partners – Medicare Advantage and Medicaid members can continue to access existing telehealth benefit offered through UHC’s designated partners without cost-sharing. Cost-sharing for commercial members will be waived through June 18, 2020.
  • Expanded Provider Telehealth Access – Eligible medical providers connecting with patients through synchronous virtual care (live video-conferencing) will be permitted to do so through June 18, 2020. All benefits will be processed in accordance with the member’s plan, with the exception of the waiver of cost-sharing for COVID-19 testing related visits.

Additionally, UHC recently announced updates to certain telehealth, coding, and reimbursement policies, including: 

Updated Telehealth Policies

Based on CMS guidance from March 17, UHC will waive CMS’ originating site restriction for Medicare Advantage, Medicaid and commercial members, so that care providers can bill for telehealth services performed while a patient is at home.

Updated Coding and Reimbursement Policies

UHC is monitoring the Centers for Disease Control and Prevention (CDC), CMS and other national and local resources to establish and update coding guidelines and reimbursement amounts. These updates include new diagnosis codes, laboratory testing codes, a new CPT® COVID-19 code, and information regarding COVID-19 laboratory testing reimbursement.

Member Coverage FAQ 

For Medicare Advantage, Medicaid and fully insured comprehensive commercial medical plans, the insurer has waived member copays, coinsurance and deductibles for COVID-19 testing at approved locations in accordance with CDC guidelines.

Complete details on UHC’s ongoing COVID-19 updates can be seen here.

CPT® is a registered trademark of the American Medical Association.
Source(s): UnitedHealthcare;