Horizon Eliminates Cost-sharing Related to COVID-19 Testing and Evaluation
Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) is waiving all cost-sharing obligations for members seeking diagnostic services related to COVID-19 when they are provided consistent with CDC guidelines. Horizon BCBSNJ previously announced that it would waive cost-sharing for the COVID-19 test. This announcement sweeps in all of the services associated with diagnosing COVID-19 when those services are delivered according CDC protocols and guidelines.
“This public health emergency is evolving rapidly and Horizon is responding just as swiftly to help ensure that cost is not a barrier to care for our members. The health and well-being of Horizon members is our highest priority, especially for those who know they have been exposed or who have symptoms consistent with COVID-19,” said Kevin P. Conlin, Chairman, President and CEO of Horizon BCBSNJ. “We applaud Governor Murphy and his administration for taking quick and decisive action to contain the spread of COVID-19 and ensure that those infected get the care they need.”
As with the previously announced cost-sharing changes, these changes take effect immediately for Horizon BCBSNJ’s fully insured members, including those covered through Medicaid, Medicare, Individual and Small Group policies, as well as members covered by the State Health Benefits (SHBP) and School Employees Health Benefits (SEHBP)Programs. The Company will continue to work with other self-insured customers that provide coverage for their employees on their specific plan designs.
Effective Immediately, Horizon BCBSNJ is:
- Waiving Cost-Sharing for all services associated with the diagnosis of COVID-19 per CDC guidelines.
- Waiving cost-sharing obligations for all charges associated with a visit to an in-network primary care physician or urgent care center or an in-network or out-of-network emergency room for evaluation of symptoms identified by the CDC as possible indicators of COVID-19 infection (fever, cough, and shortness of breath).
- Waiving cost-sharing obligations for all charges associated with a visit to an in-network primary care physician or urgent care center or an in-network or out-of-network emergency room for COVID-19 testing for members who know they have been exposed to an individual diagnosed with COVID-19.
- Waiving cost-sharing obligations at in-network and out-of-network labs for charges associated with the delivery of services connected to CDC approved lab studies or tests for COVID-19 for members who know they have been exposed to an individual diagnosed with COVID-19 or with symptoms identified by the CDC as possible indicators of COVID-19 infection (fever, cough, and shortness of breath).
- Directing that physicians and facilities are prohibited from billing any fully-insured Horizon BCBSNJ member or SHBP/SEHBP member for any services connected to COVID-19 evaluation or testing, provided that the patient meets the CDC criteria.
- No prior authorization is required, however, consistent with standard protocols and network agreements, treating physicians and facilities must document symptoms or a patient’s self-reported known exposure in the medical record.
- Physicians or facilities treating members whose insurance ID card indicate they are covered under a self-insured plan should contact Horizon Physician Services to determine that member’s cost-sharing obligation.
- Medically necessary services associated with diagnosis code (i.e., ICD-10 Z20.828 or Z03.818) should be included in any billing submission to eliminate cost-sharing and to receive timely compensation for services.