Patients encouraged to use telehealth services to communicate with their providers during difficult times

March 31,2020 - OAKLAND, Calif. — On Monday, Insurance Commissioner Ricardo Lara and the California Department of Insurance directed health insurance companies to provide increased telehealth access for consumers during the declared COVID-19 state of emergency. Health insurance companies must continue to provide access to medically necessary care and California policyholders should be able to access medically necessary health care without physically visiting their provider in person, when clinically appropriate.

This action affects two million Californians covered by Department of Insurance-regulated health policies.

“Being able to interact with your health care provider electronically will protect vulnerable people from unnecessary in-person visits with their health providers and get them help faster,” said Insurance Commissioner Ricardo Lara. “Increasing access to telehealth helps consumers comply with social distancing guidelines, protects the health of vital health care providers, and guarantees access to care for our most vulnerable during these extraordinary times.”

The Notice from Commissioner Lara directs that health insurance companies provide increased access to health care services through telehealth and encourages patients to use telehealth delivery options, so as to limit the amount of in-person health care they seek while continuing to receive the essential care that they need during this challenging time. Cost-sharing requirements for services delivered via telehealth should be consistent with, or no greater than, the cost-sharing requirement for services delivered through in-person settings.

The Notice also provides that insurance companies should:

• Allow all network providers to use all available and appropriate modes of telehealth delivery including, but not limited to, synchronous video, and telephone-based service delivery
• Immediately implement reimbursement rates for telehealth services that mirror payment rates for an equivalent office visit
• Eliminate barriers to providing medically and clinically appropriate care using appropriate telehealth delivery models
• Use telehealth service delivery methods to enable consumers to have access to mental health and substance use disorder services, family therapy, and behavioral health services, including services to treat autism, among others

On March 18, Commissioner Lara directed health insurance companies to maintain health care access during the COVID-19 emergency including prescription refills. Insurance companies were required to submit emergency plans on prescriptions, maximizing telehealth, and ensuring network provider adequacy.

Link to Notice

The current declared COVID‑19 state of emergency has the “immediate potential to displace insureds” within the meaning of Insurance Code section 10112.95(b). Specifically, the COVID‑19 outbreak has the immediate potential to displace consumers in terms of their ability to access needed medical care, whether through voluntary self-isolation, mandatory shelter-in-place or quarantine orders, or displacement in terms of the ability to access their homes, workplaces, schools, child or dependent care providers, or local communities. For millions of Californians, this potential has already been realized as schools have closed and businesses shuttered as a result of state and local government orders.

Additional information on the novel coronavirus (COVID-19)
Source: CA. Dept. of Insurance