COVID-19 Coronavirus Update

No, health care providers must not charge health plan members for the providers’ use of these supplies (known as Personal Protective Equipment, or PPE). Any provider that has charged their patients fees to cover the cost of PPE must refund those patients in full.

If your provider charged you for those supplies, please contact Independent Health’s member services department using the number on the back of your ID card.

Treatment:

• Independent Health covers all services and treatment for our members with no member cost share, including in-person, telehealth, urgent care center, outpatient hospital or emergency room visits when the primary purpose of the visit is COVID-19 testing, diagnosis and treatment.
• This coverage applies until further notice to all fully insured commercial plans (including HSA-qualified high deductible health plans), Medicare Advantage, State Products and Individual plan members.
• Coverage for self-funded employer plans varies by employer group. Members who are Self-Funded through your employer should contact us at (716) 631-2661 or 1-800-257-2753 for more information on telehealth benefits and the cost. The back of your member ID card indicates “Medical benefits administered by Nova.”

Testing:

• Independent Health covers all laboratory testing and services related to the diagnosis of COVID-19 with no member cost share.
  • Members of our State products (MediSource, Essential Plan, Child Health Plus) must use participating in-network provider for these services. (These products follow specific coverage guidelines).
  • However, Independent Health does not cover Covid-19 testing for screening purposes, such as:
    • Test required by an employer, or to attend school (both students and staff)
    • To attend events such as weddings, sports games, concerts and other entertainment
    • To participate in a sport or team activity
    • Public health surveillance, such as testing for travel purposes
    
    If you are seeking testing for reasons not related to diagnosis and treatment, please discuss your options with the person or organization (e.g. employer, school) asking you to be tested.
    
    Government-run sites do not require insurance and may be available to you. However, these sites may prioritize testing resources to those most in need, including but not limited to those with active symptoms, essential workers, or those contact traced and under quarantine. (Self-funded coverage may vary by plan).
  • For information on Antibody testing coverage, please refer to the question “Is COVID-19 antibody testing covered by my plan?”

Telehealth and Telemedicine:

Independent Health currently covers all in-network telehealth/telemedicine services in full with $0 cost-share, even if the service is not related to COVID-19.

However, please note: As August 1, 2021, a cost share will apply to telehealth and telemedicine services not related to COVID-19 on commercial plans. The amount of cost share depends on the member’s benefit plan.

Medicare members are responsible for the cost share associated with ancillary services (e.g. dietitians).

Members who are Self-Funded through your employer should contact us at (716) 631-2661 or 1-800-257-2753 for more information on telehealth benefits and the cost.

Teladoc^®:

We encourage members to contact their primary care physician for their medical needs, but we also know this isn’t always possible. When you can’t reach your primary care physician, Teladoc* allows members to talk with a doctor anytime, anywhere by phone, mobile app or online 24 hours a day, 7 days a week.

We are currently waiving the cost share for all Teladoc services during the COVID-19 outbreak.

However, please note, as August 1, 2021, a cost share will apply to Teladoc services not related to COVID-19 on commercial plans. The amount of cost share depends on the member’s benefit plan.

*Teladoc is not available to MediSource, MediSource Connect, Essential Plan and Child Health Plus members.

If you seek treatment for a health issue, illness or injury that is unrelated to COVID-19, you will be responsible for paying the standard copays or coinsurance per your current benefits.

Due to the emergency declaration, Medicare Advantage members may obtain care from out-of-network providers at the in-network cost sharing. For more information, see the page called “Getting care during a disaster.”

At this time, antibody testing is covered with no cost-share if the test is determined to be medically appropriate and ordered by your healthcare provider.

If you are Medicare Advantage member, you do not need an order from your provider but we encourage to speak with your provider about the benefits of testing

If you are a member of State Program or Product (MediSource, Child Health Plus, or Essential Plan): If you are enrolled in a State Program with Independent Health, we strongly encourage you to work with your primary care provider or other healthcare providers who participate with Independent Health to help decide and arrange COVID-19 virus or antibody testing. If it is not an emergency, you have to get your services from in-network providers. Working with in-network providers will help ensure you are not billed in error by providers that do not participate with Independent Health.

If you are a member of a self-funded group: Members who are Self-Funded through your employer should contact us at (716) 631-2661 or 1-800-257-2753 for more information about this coverage. The back of your member ID card indicates “Medical benefits administered by Nova.”

What you need to know about antibody tests
Antibody tests look for past infection with the coronavirus that causes COVID-19. After someone has been infected with the coronavirus, their body usually produces antibodies in response to the infection. Antibodies are proteins that help fight off infections.

Depending on when someone was infected and the timing of the antibody test, the test may not find antibodies in someone’s blood with a current COVID-19 infection, because it can take one to three weeks for antibodies to appear after symptoms occur. This means a person infected with COVID-19 may not yet have developed antibodies, leading to a negative test result.

The CDC has advised that antibody tests should not be used to diagnose an active COVID-19 infection. In addition, medical experts do not know yet if having antibodies to the virus can protect someone from getting infected with the virus again, or how long that protection might last. For these reasons, it is important that you discuss with your primary care provider the value of antibody testing. If your primary care provider orders antibody testing for you, you should be sure to follow up with your provider to discuss your test results and what they may mean.

The lab that conducts the test is required to tell you:

• If the test has not been reviewed by the Food and Drug Administration.
• False negative results can occur. You could have infection not detected by the test.
• False positive results can occur. Positive results may be due to past or present infection with non-COVID-19 coronavirus strains such as the common “cold.”
• Results from antibody testing should not be used as the sole basis to diagnose or exclude COVID-19 infection, or to inform infection status.

Independent Health does not cover COVID-19 testing when it is required for returning to school, for public health surveillance, or for any other purpose not intended to diagnose or treat an individual. Free testing is available to the public through the New York State Department of Health and each county’s health department.

You must check with your health care provider to determine if the test is medically appropriate.

Many doctors’ offices offer telehealth visits so they can treat their patients by phone, email, online portal or video. This depends on each doctor office, so check to see if your doctor offers this service.

Independent Health currently covers all in-network telehealth/telemedicine services in full with $0 cost-share, even if the service is not related to COVID-19.

However, please note: As August 1, 2021, a cost share will apply to telehealth and telemedicine services not related to COVID-19 on commercial plans. The amount of cost share depends on the member’s benefit plan.

Medicare members are responsible for the cost share associated with ancillary services (e.g. dietitians).

Self-funded Plans: Members who are Self-Funded through your employer should contact us at (716) 631-2661 or 1-800-257-2753 for more information on telehealth benefits and the cost.

Teladoc® may be available also. Please refer to the question “How am I covered for services related to COVID-19?” (Teladoc is not available to MediSource, MediSource Connect, Essential Plan and Child Health Plus members. Additionally, members who are Self-Funded through your employer should contact us at (716) 631-2661 or 1-800-257-2753 for more information on benefits and the cost.)

We also offer a 24-Hour Medical Help Line, which allows our members to speak with an experienced registered nurse to get answers to questions. The nurses can help members learn more about the treatment and procedure options available for different health problems and diseases. The phone number for the 24-Hour Medical Help Line can be found on the back of your Independent Health member ID card.

Now, more than ever, it is very important to have a primary care physician. A primary care physician (PCP) can properly coordinate your care and serve as the central source for information and guidance on all matters of your health and well-being – even if you’re healthy.

Not sure how to choose the right PCP for you? We can help. Contact Member Services by phone or e-mail.

In the meantime, you may be able to use our telemedicine benefit through Teladoc*, which allows you to talk with a doctor anytime, anywhere by phone, mobile app or online 24 hours a day, 7 days a week.

In addition, we offer a 24-Hour Medical Help Line, which allows our members to speak with an experienced registered nurse to get answers to questions. The nurses can help members learn more about the treatment and procedure options available for different health problems and diseases. The phone number for the 24-Hour Medical Help Line 1-800-501-3439.

If you are thinking of going straight to a facility or hospital for care, we encourage you to call ahead and discuss your concerns with their staff first.

*Teladoc is not available to MediSource, MediSource Connect, Essential Plan and Child Health Plus members. Additionally, members who are Self-Funded through your employer should contact us at (716) 631-2661 or 1-800-257-2753 for more information on benefits and the cost.