This article was revised on June 30, 2021, to update the effective timeline for testing and treatment coverage, and treatment content.​

Coverage of member cost-share

As previously communicated, Independence is waiving member cost-sharing (i.e., copayment, deductible, and coinsurance) for the following services:

• Testing. Independence will waive member cost-sharing for certain COVID-19 diagnostic and antibody tests in accordance with federal guidelines and company medical policy for the duration of the COVID-19 pandemic. For complete details, please review the policy News Article, Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)):

  • Comm​ercial
    
  • Medica​re Advantage​

• Inpatient treatment (see table for effective dates). 

  Co​mmercial​

• Independence will waive member cost-sharing for in-network, inpatient, acute care treatment of members diagnosed with COVID-19​.

• Independence will waive member cost-sharing for emergency room/department (ED) visits associated with admissions for in-network, inpatient, acute care treatment of COVID-19 whether for medical or behavioral health.*

Medicare Adv​antage

• As part of the filed benefits for Medicare Advantage business in 2021, there is no cost-sharing for in-network inpatient acute care treatment associated with COVID-19.
• Independence will waive cost-sharing f​or ED visits associated with admissions for in-network, inpatient, acute care treatment of COVID-19, whether for medical or beh​avioral health through the end of the public health emergency. 

​​​​Children's Health Insurance Program (Keystone HMO CHIP)

• ​​​​​​​​Standard coverage includes no member cost-sharing for in-network, inpatient acute care treatment whether COVID-19 related or not.
• ​​Standard coverage waives ED visit copayments for admissions whether COVID-19 related or not.

*Cost-sharing is not waived for outpatient services provided in the ED.

We also communicated that self-funded customers can opt-out of waiving cost-sharing for the treatment of COVID-19; therefore, some Commercial members may still be required to pay their applicable cost-share. For High Deductible Health Plans, in-network cost-sharing waivers detailed above will remain in effect through October 31, 2021, unless prohibited by law.

Claims processing

Processes have been implemented to ensure provider payments are accurate and claims are processed in a timely fashion and in accordance with applicable law and regulatory guidance.

The following chart outlines how claims will be processed for the various services provided to Commercial, Medicare Advantage, Medicare Supplement, and Keystone HMO CHIP members – specifically regarding member cost-sharing:

For information on how we are processing claims for PCP telemedicine services, please read this article.

Payment adjustments

If cost-sharing was inadvertently applied to the claim and it should have been removed, the claim will be adjusted to pay the provider the correct amount. We ask that providers wait until after the claim has been processed, and adjusted, to bill the member for any applicable cost-share noted on the Provider Explanation of Benefits.

As a result of the processes we have implemented, you will not need to contact the call center or submit a claim investigation via PEAR Practice Management on the Provider Engagement, Analytics & Reporting (PEAR) portal to request an adjustment.​

Learn more

Read more about our coverage of services during the COVID-19 public health emergency in our News Articles on our Medical and Claim Payment Policy Portal.

• Commercial
• Medicare Advantage​

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