Getting your Trinity Audio player ready...

From North Carolina Department of Insurance

RALEIGH — North Carolina Insurance Commissioner Mike Causey has asked the state’s  insurance companies to unify processes and remove barriers to make it easier for citizens to obtain diagnostic testing and treatment needed for COVID-19.

“It’s critical we have consistency within the industry as we think outside the box to help our citizens,” Causey said. “I am also working with the medical community to ensure claims can be processed in a timely manner so that patients may have access to funds as soon as possible.”

Causey has asked insurers to waive prior authorization for COVID-19 diagnostic tests and covered services — and to provide these at no cost to the insured. In addition, he has asked them to speed access to certain drugs and to make expedited formulary exceptions if needed or if there is a shortage of a certain medication. This would apply to patients diagnosed with COVID-19 who fit into one of two categories: 1) those suffering with other health conditions for which the virus would seriously jeopardize their health, life and ability to regain maximum function, and 2) those undergoing treatment using a non-formulary prescription drug intended to lessen symptoms or the duration of the virus.

Causey has also encouraged insurers to expand telehealth services. Telehealth connects patients and clinicians electronically and enables the patients to get help without exposure. The links to the various carrier’s telehealth policies are posted on the North Carolina Department of Insurance website.  

He is also calling for consistency in coding including that of out-of-the box services such as curb-side help. Curb-side service allows clinicians to consult with symptomatic patients while they remain in their vehicles. The intent is to spare patients of making unnecessary trips to an emergency room to decrease the spread of infection.

With hospitals and surgery centers now canceling many elective procedures, the commissioner also requests that insurers extend their preapproval time limits. This will enable patients to reschedule their elective procedures at a safer time without the delay of the pre-authorization process.

In addition to removing barriers that could prevent North Carolinians from receiving lifesaving help, Commissioner Causey asks insurers to enact the following:

• Review internal processes and operations to ensure readiness to address COVID-19 cases.
• Consider policy revisions to streamline responses and benefits for their insured populace.
• Inform their insured of available benefits.
• Respond quickly to inquiries.
• Post updated information on websites.
• Enact staff helplines to minimize wait times.
• Promptly notify providers, helpline staff and customer service personnel on policies regarding COVID-19.
• Verify that provider networks are adequate to handle the increases as more COVID-19 cases are diagnosed in North Carolina.

For updated information on NCDOI’s response to the COVID-19 health emergency, visit ncdoi.com.