UNWAVERING SUPPORT IN UNPRECEDENTED TIMES

For the duration of the Massachusetts state of emergency:

We will waive all member cost share for medically necessary COVID-19 testing, counseling, vaccines (when available), and treatment and supportive care at in-person doctor's offices, urgent care centers and emergency departments (excluding inpatient care) in accordance with CDC and DPH guidelines.

Any medically necessary treatment for coronavirus is covered under a member's health plan within the United States or internationally.

Blue Cross also has waived cost share for all covered services (COVID-19 and non-COVID-19 related) delivered by an in-network provider via telehealth or telephone (both medical and behavioral) services, not just those related to COVID-19. This is effective as of March 16, 2020.

We will also cover the cost of vaccination when a COVID-19 vaccine is available.

Members with a COVID-19 diagnosis who receive medically necessary out-of-network care in a doctor’s office, urgent care center, or emergency department will be covered as in-network, cost shares would be waived, and the member would be protected against balance billing. The cost share protections do not extend to in-patient care.

Please understand that your health care provider may perform additional tests and procedures during the same visit in which they test for COVID-19. Copay, co-insurance and deductible may apply for those other tests and services.

Yes, Blue Cross Blue Shield has temporarily lifted limits on early refills of prescription medications allowing members to obtain one additional fill of their existing prescription.

Please note: the prescribing physician or pharmacy filling the prescription may decide to continue to impose limits at their discretion.

Certain medications, such as opioids and medications with quality care dosing limits, are excluded.

Members can get two-month supply of a medication for two copays at the retail pharmacy of their choice, as benefits allow. Additionally, members can use the ESI mail order to get three month supplies of medications.

If a member is enrolled in Smart90, they are eligible for 90-day supplies at retail for certain maintenance medications.

We will not allow for greater than a 90-day supply to avoid stockpiling or potential shortages.

We understand some pharmacies may not understand Blue Cross has lifted restrictions on early refills.

We are working with our pharmacy benefits manager to resolve this issue

If your employees are being told Blue Cross is denying refills the employee can call our member service line for assistance while in the pharmacy.

Please remember, prescribers and pharmacies can maintain these limits at their discretion.

No, we can’t allow accounts to opt out of this program. This is in keeping with state guidance during this state of emergency and is our standard process anytime there is a disaster such as tornado, hurricane, or other emergency.

No, opt outs are not allowed. This is consistent with state and federal guidance (including specific Division of Insurance guidance) aimed at preventing the spread of the coronavirus by allowing remote health care access.

We are in close contact with our pharmacy benefit manager, Express Script and our specialty pharmacy network. There is no supply issue at this time. In collaboration with our pharmacy partners we will continue to monitor the supply of medications and will be flexible in allowing alternative medications should a there be a shortage of medications in our formulary.

Our company is considered an essential business and is prepared to continue to operate during this outbreak in Massachusetts. We have stress-tested disaster readiness and pandemic plans in place. We have convened a cross-functional group of leaders and associates who are evolving our plans to meet the needs of this event. Strategic elements of our plan include:

• The ability operate our business when are buildings are closed. More than 90% of our associates are equipped to work remotely.
• Our Virtual Private Network is redundant and is built to meet the demands placed on it should all associates wind up working remotely
• Our company is financially stable and has a healthy reserve fund, should we need it, to finance our operations.

If you have additional questions about our preparations, please speak to your account executive.

Yes, we expect to cover all claims for medically necessary covered services provided to members we insure.

Accounts that self-insure remain responsible for covered health care costs incurred by their employees.

Our message to our associates is based on the latest information from the CDC, the Massachusetts Department of Public Health and state government.

With the rise in cases in Massachusetts and the Governor’s declaration of a state of emergency, the majority of our associates are working from home to ensure their health and wellbeing and to support of public health efforts to prevent the spread of COVID-19.

We urge associate to practice social distancing and basic hygiene that helps prevent the spread of viruses:

• Wash your hands frequently with soap and water
• Don’t touch your mouth nose or eyes
• Cover your nose and mouth with a tissue or crook of your arm when you sneeze or cough

• Stay home when you are sick

We share the latest information with our associates as appropriate through a variety of channels including email, intranet and our public news site Coverage

You doctor will determine if you should be tested in accordance with Massachusetts Department of Public Health guidelines.

The Massachusetts Department of Public Health, the Centers for Disease Control and Prevention, and the World Health Organization are all providing regular updates on their websites:

• https://www.cdc.gov/coronavirus
• https://www.mass.gov/orgs/department-of-public-health
• https://www.who.int/

In addition to our coronavirus resource center we’re also providing information on our health news site, Coverage

Yes, accounts can add telehealth services via our provider, Well Connection off cycle. The cost is 50-cents per employee per month.

It may take several weeks to add this benefit.

Please contact your account executive for details.

No, accounts are still responsible for the paying for telehealth services. The cost is 50-cents per employee per month.

We have created the COVID-19 Information Center for our Clinical Partners. It is continually updated with the latest key information our health care partners need regarding our approach to telehealth and telephonic care, COVID-19 testing and treatment, referrals and authorizations, cost share, prescription medications, dental care, and more. This page is available at Provider Central. No login is required.

There are no prior authorizations and referrals required for members receiving medically necessary care for COVID-19. To help us expedite all COVID-19 cases, we’ve asked providers to please continue to notify us of all inpatient admissions. No supporting clinical information and no medical necessity reviews will be required.

Detailed information on billing and codes, as well as updates to our policies are available on Provider Central. We also posted specific articles for medical and dental providers on March 24. 

The Centers for Disease Control and Prevention have issued an interim set of coding guidelines available here.

Blue Cross is financially stable. We maintain a reserve fund that, if needed, will fund our operations.

We are following guidance from the state, which has declared a state of emergency and taken a number of steps to slow the spread of the virus.

Regularly updated information is available on this site and on our health news site, Coverage.

Our message to our associates is based on the latest information from the CDC, the Massachusetts Department of Public Health and state government.

With the rise in cases in Massachusetts and the Governor’s declaration of a state of emergency, the majority of our associates work from home to ensure their health and wellbeing and to support of public health efforts to prevent the spread of COVID-19.

We urge associate to practice social distancing and basic hygiene that helps prevent the spread of viruses:

• Wash your hands frequently with soap and water
• Don’t touch your mouth nose or eyes
• Cover your nose and mouth with a tissue or crook of your arm when you sneeze or cough
• Stay home when you are sick

We share the latest information with our associates as appropriate through a variety of channels including email, intranet and our public news site Coverage.

For the duration of the Massachusetts state of emergency and effective for dates of service retroactive to March 16, 2020, in-network providers may deliver all medically necessary covered services (COVID-19 AND non-COVID-19 related) via any modality. This includes telehealth, telephonic, video chat or in-person to all Blue Cross Blue Shield of Massachusetts members including members in our Medicare Advantage, Managed Blue for Seniors and Medex plans.

Starting immediately, Blue Cross will cover visits by telephone (“telephonic visits”). Providers may offer telehealth services as long as they are contracted and credentialed by Blue Cross Blue Shield of Massachusetts. There are no additional credentialing or contracting processes providers need to follow to offer these services.

We will reimburse medically necessary telehealth and telephonic visits at the same rate as an in-person visit, for all provider specialties, including ancillary. 

Removing all member cost share (copayments, co-insurance, and deductibles) for a medically necessary telephone (telephonic) call visit in place of an office visit, and a virtual/video appointment (telehealth) services for COVID-19 and non-COVID-19-related services.

For Federal Employee Program (FEP) members:

Effective March 10, 2020, we’ve removed the member cost share for all telehealth services (COVID-19 and non-COVID-19-related) received through the Teladoc network. Members can register for Teladoc by visiting fepblue.org/coronavirus. For other providers offering telehealth services not on Teladoc, the applicable office visit cost share will apply (unless COVID-19 related).  

Please visit Provider Central for the latest information on coding and billing. We have created a COVID-19 Information Center for our Clinical Partners on Provider Central.