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.

Independent Health will cover the following services with no member cost share for our commercial group and individual plans (including HSA-qualified high deductible health plans), Medicare Advantage and State programs until further notice:

• Care received when ordered by a health care provider as part of a COVID-19 treatment plan.
• 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, testing is not covered if ordered or required by a third party, such as: government/public agency to determine community spread, or by an employer for return-to-work or weekly testing, or for school or camp purposes. If you are seeking testing for reasons which are 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).
• 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.”
• Antibody testing with an order or prescription from a primary care provider. (While CMS regulations do not require a provider’s order for Medicare Advantage members, we encourage providers to discuss the benefit of the test with those members.)

Telehealth and Telemedicine: To encourage social distancing and help reduce the risk of spreading this virus, Independent Health will cover any in-network telehealth/telemedicine services, whether or not COVID-19 related. There will be $0 copay or cost-sharing* for members for these services.

*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^®: Although we encourage our members to contact their primary care physician for their medical needs, we realize this isn’t always possible. So, when you can’t reach your primary care physician, Independent Health’s telemedicine benefit is provided through Teladoc* allows you to talk with a doctor anytime, anywhere by phone, mobile app or online 24 hours a day, 7 days a week. We will waive the cost share for Teladoc services during the COVID-19 outbreak for our members’ ease and convenience. Learn more about Teladoc including how to get started.

*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 Teladoc benefits and the cost.

No. You will not have to pay for COVID-19 testing ordered by a health care professional, including at a doctor’s office, urgent care center or emergency room. All laboratory testing and diagnostic services that occur for testing and diagnosis of COVID-19 will have no member cost share* for all plans, including HSA-qualified high deductible health plans (HDHPs).

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, testing is not covered if ordered or required by a third party, such as: government/public agency to determine community spread, or by an employer for return-to-work or weekly testing, or for school or camp purposes. If you are seeking testing for reasons which are 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).

Independent Health will cover 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

To encourage social distancing and help reduce the risk of spreading this virus, Independent Health will cover any in-network telehealth/telemedicine services, whether or not COVID-19 related.

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.

The following table summarizes outpatient testing options. If your symptoms are severe, this table does not apply. Immediately consult a physician and/or go to an urgent care facility or emergency room.

Members should consult their Primary Care Physician to determine the appropriate testing option.

Before you are tested for COVID-19, Independent Health strongly encourages you to:

• Speak with your Primary Care Physician (PCP). He or she will determine if COVID-19 Testing is appropriate. Additionally, most laboratories will not perform a test without an order from a health care professional. (Medicare Advantage members do not need an order).
• Consider testing options available through county health departments. Testing through sites set up by county health departments is free to the public (In some instances, urgent care centers will charge a copay for the visit). Phone numbers for appointments for county-operated testing sites are listed on the County Health department websites.

Types of Tests

There are different types of laboratory tests for COVID-19:

• Polymerase Chain Reaction (PCR), also referred to as Molecular testing, determines an active infection of the virus causing COVID-19, usually through a nasal or throat swab. Specimens are sent to an outside laboratory with results returned typically within 3 to 5 days.
• Antigen Testing is another method of determining an active infection for COVID-19, also through a nose or throat swab. Unlike PCR, antigen test results are available within minutes rather than days. Experts caution that results often are not reliable enough to fully rule out COVID-19 infection.
• Antibody Testing checks to see if you may have been exposed to the virus that causes COVID-19, even if the virus is no longer in the body. The antibody test cannot be used by itself to diagnosis an active infection. When accurate, while an antibody test may determine if you’ve had the virus in the past, it cannot tell how strong the immunity is or how long it may last to prevent future infection.

Testing for the COVID-19 virus or the antibody required by an employer is the employer’s responsibility. Therefore, if COVID-19 virus or antibody testing is required for going or returning to work, please check with your employer for further information and guidance. Independent Health does not cover testing that is a requirement for going or returning to work.

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.

Yes, to confirm the test is medically appropriate, you need an order from your doctor before you get tested in order for the test to be covered with no cost share. Your primary care provider will determine if you need a test based on medical criteria. and will ensure that the costs of the testing are covered. Certain testing sites may not require a prescription but may also ask for payment in advance and reimbursement for covered services will have to be submitted and processed by Independent Health. To reduce out-of-pocket cost, you may go to one of the county or State testing sites.

If you are a Medicare Advantage member, you do not need a doctor’s order, but we encourage you to speak with your health care provider about the benefits of testing.

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

Many physician practices have been working to set up telehealth capabilities so they can treat their patients through remote technologies in lieu of a patient visit. The availability of telehealth services varies by physician practice. These services can include consultation by phone, email, online portal or video.

At this time, we have removed the member cost share* for any in-network telehealth services, even if it’s not COVID-19 related. We have expanded this coverage to encourage social distancing and help reduce the risk of spreading this virus. You should check with your doctor’s office to see if it provides telehealth services. Each practice may have their own way of scheduling and conducting these types of services.

If your doctor does not offer telehealth services or you are having difficulty reaching your doctor due to increased call volume, 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. We have waived the member cost share for Teladoc services during the COVID-19 outbreak for your ease and convenience. For more information, click here.

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 can be found on the back of your Independent Health member ID card.

*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.

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. For more information, click here.

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.