New York: Gov. Cuomo announces Coronavirus testing will be cost-free for all (insured) residents

Yesterday the first confirmed case of coronavirus (COVID-19) was reported in the nation's largest city:

A 39-year-old Manhattan woman has tested positive for COVID-19, more commonly known as the novel coronavirus, Gov. Andrew Cuomo said late Sunday. She is the first confirmed case in the city and in the tri-state area.

"The patient, a woman in her late thirties, contracted the virus while traveling abroad in Iran, and is currently isolated in her home," Cuomo said in making the announcement late Sunday.

The governor said that the woman is a health care worker, and that her background allowed her to take the appropriate precautions and seek testing. She flew back to New York on Tuesday but did not take mass transit home, Cuomo said Monday. As a precaution, the people on her flight and the ride-share driver are being notified about potential exposure, but Cuomo said the woman was not thought to be contagious at that time. She has respiratory symptoms but Cuomo described them as mild.

Her husband, also a health care worker, is in isolation with her at their Manhattan home. He is also being tested for the virus, but results aren't back yet. Cuomo said officials are assuming he has it as well.

Today, New York Governor Andrew Cuomo made the following announcement:

BREAKING: I am announcing a new directive requiring NY health insurers to waive cost sharing associated with testing for #coronavirus, including emergency room, urgent care and office visits.

We can't let cost be a barrier to access to COVID-19 testing for any New Yorker.

— Andrew Cuomo (@NYGovCuomo) March 3, 2020

New Yorkers receiving Medicaid coverage will not have to pay a co-pay for any testing related to #coronavirus.

Currently all COVID-19 tests being conducted at the State's Wadsworth Lab are fully covered.

— Andrew Cuomo (@NYGovCuomo) March 3, 2020

I don't see anything explaining what he intends to do for New Yorkers who aren't insured, but it's a start, I guess.

I don't know how this will work in practice...perhaps the state will reimburse insurance carriers for the cost or something...but regardless, this is exactly what they should be doing at the moment. Of course what should actually happen is the federal government should be footing the bill for everyone to get tested (or at least those who the CDC recommends) seeing how this is turning into a pandemic and all, but whatever; in the meantime, good for Gov. Cuomo.

UPDATE: An important caveat to the above:

This is a good move, and other states should do the same thing. But 61% of workers who have employer-sponsored insurance are covered under self-insured plans, and states can't regulate those (they're regulated by the feds instead, under ERISA).

— Louise Norris (@LouiseNorris) March 3, 2020

As Josh Schultz noted in response, this at the very least will put plenty of pressure on those self-insured companies to follow suit, and if enough states follow NY's lead it'll put pressure on the Dept. of Labor as well, but in the meantime, that's a whole lot of people in New York who aren't covered by Cuomo's executive order.

UPDATE: Michael Capaldo, an ACA consulting & employee benefits specialist, has written up a post over at LinkedIn which provides some additional details on just how Gov. Cuomo's directive will work in New York State:

  • Fully-insured employer-sponsored health plans, individual health plans and Medicaid plans will cover the cost of COVID-19 related testing without any co-pays or other cost sharing, including testing at emergency rooms, in-network urgent care and in-network office visits.
  • Self-funded employer-sponsored plans that are not subject to state regulatory authority may choose to waive cost-sharing for COVID-19 testing as a mid-year change in coverage if such a change is needed.
  • Additionally, NYS insurers were directed to take the following steps:
  • Keeping Consumers Informed: The NYS Department of Financial Services (DFS) is directing insurers to devote resources to inform consumers of available benefits, quickly respond to consumer inquiries, and consider revisions needed to streamline responses and benefits for consumers.
  • Providing Telehealth Medical Advice & Treatment: DFS is directing insurers to develop robust telehealth programs with their participating providers where appropriate, particularly for individuals who may have difficulty making an office visit and where a phone call with a medical professional can alleviate the need for a hospital visit.
  • Preparing Health System for Increased Cases: DFS is directing insurers to verify that their provider networks are adequately prepared to handle a potential increase in the need for health care services, including offering access to out-of-network services where appropriate and required, in the event more COVID-19 cases are diagnosed in New York. In addition, DFS is reminding insurers that lifetime or annual limits cannot be placed on in-patient care.
  • Covering Costs if Immunization Becomes Available: In the event an immunization becomes available for COVID-19, DFS is reminding insurers that they must cover the cost of vaccination for children under 19. For adults, DFS's guidance states that all insurers should be prepared to cover the immunization immediately at no cost-sharing.
  • Expanding Access to Prescription Drugs: With reports of prescription drug shortages due to supply chain issues, DFS is directing insurers to provide insurance coverage for off-formulary prescription drugs if there is not a formulary drug available to treat the insured, through a formulary exceptions process as required by law.
  • Ensuring Emergency Care: DFS is reminding insurers that coverage for emergency services in hospital facilities is required at the in-network cost-sharing even if the hospital is out-of-network or overseas, and that no insurer may require a patient to seek preauthorization prior to seeking emergency care, including for ambulance service.
  • Surprise Medical Bills: DFS is directing insurers that they are required to hold harmless insureds who receive surprise medical bills for health care services, including those related to testing and treatment of COVID-19.