Hopes to work with insurers to continue flexibility, including waivers, throughout the pandemic
Nov. 6, 2020 (ACP) – The American College of Physicians is very concerned about the potential risk of private insurance companies eliminating waivers during the coronavirus pandemic. The waivers are crucial for patient health and physician reimbursement.
“During this time of uncertainty, insurers are starting to take away the crucial flexibilities that they granted earlier during the pandemic,” said Brian Outland, ACP director of regulatory affairs. “Some insurers have announced they'll stop waiving cost sharing for telehealth services and even some in office visits. They may also eliminate waivers of prior-authorization requirements and other forms of flexibility.”
According to a report in The New York Times, “Two of the largest health insurers, Anthem and UnitedHealthcare, are no longer waiving co-payments and deductibles for some [patients] beginning on Oct. 1.” People who have been relying on telehealth to avoid the risk for potential exposure in the emergency room or a doctor’s office during the coronavirus pandemic “will need to check with their insurers to see how much they will now owe for a virtual visit.”
As the Times noted, insurers have made billions of more dollars than usual this year despite the pandemic. Anthem's net income for the second quarter more than doubled during the same period in 2019 to $2.3 billion, and UnitedHealthcare's net income rose by nearly double to $6.7 billion. They made more money during the first wave of the pandemic because fewer Americans were visiting medical offices and undergoing elective care due to fear that they'd be infected with COVID-19.
ACP is deeply disturbed by the refusal of the insurers to keep the copay waivers in place. “These patients may not want to go back to the physical offices of their physicians,” Outland said. “And some aren't working and may not have the funds to pay copays for any appointments regardless of whether they're in person or via telehealth.”
ACP is also concerned about other prospective moves by insurers. For one, they may remove prior authorization waivers for certain drugs and medical supplies like oxygen. For another, they may restore limits on early prescription refills, a move that could force patients to make more visits to drugstores during outbreaks. And ACP is worried that private insurers may eliminate reimbursement for telehealth visits. “Physicians and patients in rural areas will especially be hurt by this move because many patients have limited access to in-person care,” Outland said.
These changes come during an especially uncertain time for physicians. Many are suffering from the financial devastation wrought by the pandemic. They must still pay for overhead like the leases of their physical offices even if patients are wary of coming in and prefer to meet via telehealth, Outland said.
Meanwhile, a third wave of the pandemic is unfolding across the nation, and its impact on primary care practices is uncertain. A new report by the Commonwealth Fund reveals that weekly adult visits to primary care doctors in early October reached – and actually exceeded – the baseline levels in early March before the pandemic. But a “twindemic” of flu and COVID-19 in the winter could scare away patients as it did earlier in 2020.
ACP is preparing letters to send to insurers and state insurance officials about the elimination of waivers and flexibility. “We'd like to see the insurers work with ACP on ways to come to an agreement to continue flexibility – including these waivers – throughout the pandemic,” Outland said. “The health of patients must be the top priority. ACP will continue to speak up on behalf of patients and physicians.”