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COVID-19 Updates

Go to our COVID-19 resource webpage for up-to-date information.

Update from MedCost on the Coronavirus (COVID-19)

At MedCost, our key objective is to protect and improve the health of our members. As the government, health and nonprofit communities work together to stop the spread of Coronavirus disease 2019 (COVID-19), we at MedCost want to provide you with recommendations, in alignment with the Centers for Disease Control (CDC), to keep you healthy. MedCost remains fully operational, with the vast majority of employees working from home; however, our offices are closed to the public due to the COVID-19 pandemic.

Coronavirus (COVID-19)

Members

For up-to-date information on the Coronavirus (COVID-19), visit the Centers for Disease Control.  If you have benefits questions, you can call the number shown on your health plan ID card during regular business hours, (8:30 a.m. to 5:00 p.m. ET, Monday through Friday) or access Live Chat on www.MedCost.com to get real-time answers and support from MedCost Customer Service. Your company’s HR professional or company benefits administrator is also a good source of information.

  • Accessing Your Benefits
    • You can access information about your benefits 24/7 by logging in to your member account at MedCost.com/MyMedCost. The My MedCost mobile app (available for download from the App Store or Google Play) also allows you to access web features.
  • Finding Care
    • If you’re experiencing cough, cold, flu, fever or other respiratory symptoms, and have reason to believe you may have come in contact with COVID-19, contact your Primary Care Physician right away. Identify your concern. Testing can only be requested by a physician who will advise you of a testing facility and next steps. To find a doctor in your network, visit MedCost.com
    • Telehealth visits may be another option for evaluation if you are experiencing the symptoms mentioned above. Telehealth providers can assess your symptoms and determine if further testing and treatment are warranted. The coverage for telehealth visits (COVID-19 and non-COVID-19), if any, and applicable cost-sharing (co-pays, co-insurance, deductibles) varies for each health plan. Log in for coverage information. If your health plan covers telehealth through Teladoc, visit Teladoc’s website for information on how to schedule a Teladoc visit and for more helpful information on COVID-19. 
  • Pharmacy (PBM) Services
    Note: Only available to members with pharmacy benefits through OptumRx. If your pharmacy benefits are not provided by OptumRx, please contact the PBM shown on your ID card for more information. 
    OptumRx Early Refill of Maintenance Medication

    Members with pharmacy benefits through OptumRx can refill their maintenance prescription medications early if they have refills remaining on file at a participating retail or mail-order pharmacy. The refill obtained will stay consistent with the standard days’ supply previously filled. OptumRx will continuously evaluate this change to determine the appropriate duration based on CDC guidance, Federal and State declarations, and other relevant data. 

     

    OptumRx Prior Authorization (PA) Extension

    As of March 19, OptumRx is automatically extending existing prior authorizations for an additional 90 days for most chronic medications that are set to expire on or before May 1, 2020. OptumRx will re-evaluate the need for further extensions thereafter. Drugs with significant abuse potential (i.e., opioids) or those that are generally dosed for finite durations or intermittently (i.e., hepatitis agents, fertility agents) as identified by OptumRx will follow the normal process for renewals. Prior authorization requirements for medications that are newly prescribed will remain in place. 

     

    OptumRx Specialty Medications Extended Supply Distribution

    During the COVID-19 outbreak, when a member calls to refill their specialty medication, Optum Specialty Pharmacy will offer members a one-time, 90-day supply of key chronic specialty medications. This policy goes into effect the week of March 23, 2020.

    • Drugs within the following categories will remain limited to 30 days’ supply only:
    • Acute medications
    • Controlled substances
    • Drugs subject to REMS programming requiring 30 day dispensing and monitoring
    • Drugs with limited expiration dating
    • Drugs where storage/handling issues would increase the risk of waste
    • Office-administered injectable/infusible therapies 
    • Drugs experiencing supply shortages 
    • Drugs dosed less frequently than once monthly 
    • Drugs whose monthly ingredient cost exceeds $10,000 

     

    This policy will not auto-dispense medications in supplies >30 days without the direct consent of the member. This policy will also not apply to members who are newly initiated on a specialty therapy. 

     

    OptumRx Hydroxychloroquine and Chloroquine Use

    Hydroxychloroquine has recently been featured in the news as a potential treatment for moderate to severe COVID-19 illness. The use of hydroxychloroquine and chloroquine in COVID-19 is causing increased utilization and risk of drug shortage. OptumRx is implementing a quantity limit for hydroxychloroquine to preserve continued supply for chronic users with existing conditions while ensuring access for treatment of COVID-19 when appropriate. This policy goes into effect March 31, 2020. 

    • Hydroxychloroquine will be limited to 30 tablets within a 90 day time period with an automatic bypass for members who have utilized at least a 60 day supply within the past 120 days.
    • Chloroquine will be limited to 30 tablets within a 90 day time period. 
    • Members newly starting on hydroxychloroquine for rheumatoid arthritis or systemic lupus will be able to request quantities beyond 30 tablets through a manual override process.
    • OptumRx will message pharmacists at the point of dispensing to encourage filling for appropriate COVID-19 use.
  • Recommendations to Prevent Transmission
    • Avoid close contact with people who are sick.
    • Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
    • Avoid touching your eyes, nose and mouth with unwashed hands.
    • Stay home when you are sick and seek appropriate care.
    • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
    • Clean and disinfect frequently touched objects and surfaces.
    • Avoid outings and gatherings with large amounts of people in close contact and maintain a distance of approximately 6 feet from others when possible.

Employers

We are closely monitoring the COVID-19 situation and have deployed our business continuity plan to protect the health of our employees while safeguarding our ability to perform the services our clients and their health plan members rely on. To help you and your members, we want to share some specific plan-related considerations:

  • Continuation of Health Coverage for Furloughed Employees

    If a furlough results in a loss of coverage under the Plan, the employee becomes eligible for COBRA. (Note that an employee does not ordinarily lose coverage while on FMLA leave or paid sick leave, but Employers should review their Plan and any applicable company policies for details.) If a furloughed employee does lose coverage and elects COBRA, an Employer may decide to continue to cover its portion of the premium, thus keeping the employee’s premium cost the same, even while they are on COBRA. For clients utilizing MedCost for COBRA Administration, our team is prepared to assist. Please contact your Account Manager for further information.

  • Coverage for Testing/Treatment

    All Plans – The Families First Coronavirus Response Act requires all group health plans and health insurers, including grandfathered health plans under the ACA, to cover testing for COVID-19 without any cost sharing (co-pays, co-insurance, deductibles). The language of the bill does not limit this requirement to in-network services. Until we receive further guidance from the federal government, we are interpreting this requirement to apply to both in- and out-of-network services.

    This bill does not address treatment for COVID-19. All medical plans for MedCost clients include coverage for treatment (in office and, if covered, virtual) of COVID-19, which is covered subject to normal cost-sharing. Health plan sponsors who choose to do so may waive applicable cost-sharing (co-pays, co-insurance, deductibles) for the treatment of COVID-19 as well.

    For HSA-Eligible High Deductible Health Plans – On March 11, 2020, the IRS issued a notice declaring that HSA-eligible High Deductible Health Plans are permitted to cover coronavirus treatment (in office and, if covered, virtual) before cost-sharing (similar to preventive coverage). See IRS Notice 2020-15. As a result, employers who chose to do so may pay for treatment for COVID-19 under HDHPs without requiring that members first meet their deductibles, and it will not interfere with members’ ability to contribute to HSA accounts. 

     

     

  • Emergency FMLA Leave

    The Families First Coronavirus Response Act created a new category of emergency FMLA leave for employees who are unable to work due to a need for leave to care for their son or daughter (under 18) whose school or place of care is unavailable due to COVID-19. MedCost’s standard plan language addresses health coverage for employees on FMLA leaves, which also applies to this new category of leave. Specifically: “During an FMLA qualified leave of absence, the Employee’s benefits under the Plan may continue as if he or she were actively at work. The Employee must continue to pay any part of the cost he or she was required to pay before the leave began.” This new category of FMLA does not apply to all employers or employees; other limitations also apply. Employers should consult their HR advisers and/or employment law counsel on the specifics of this new FMLA category.

  • Mental Well-Being Services

    For clients with MedCost Behavioral Health, online emotional support is available for your members. myStrength has multiple resources available for participants regarding coping skills and management of fear and anxiety related to COVID-19. Members can access myStrength from the secure member portal on MedCost.com/MyMedCost, under the Healthy & Whole option.

  • Pharmacy (PBM) Services
    OptumRx Early Refill of Maintenance Medication

    For employers working with OptumRx, the “refill-too-soon" edits have been lifted for all groups/members. Members with active eligibility may obtain an early refill of their prescription medications if they have refills remaining on file at a participating retail or mail-order pharmacy. The refill obtained will stay consistent with the standard days’ supply previously filled by the member as allowed by their plan (e.g., 30- or 90-day supply). OptumRx will continuously evaluate this change to determine the appropriate duration based on CDC guidance, Federal and State declarations, and other relevant data. If you are not utilizing OptumRx, you should contact your PBM directly.  

     
    OptumRx Prior Authorization (PA) Extension

    As of March 19, OptumRx is automatically extending existing prior authorizations for most chronic medications that are set to expire on or before May 1, 2020, for an additional 90 days. OptumRx will re-evaluate the need for further extensions thereafter. Drugs with significant abuse potential (i.e., opioids) or those that are generally dosed for finite durations or intermittently (i.e., hepatitis agents, fertility agents) as identified by OptumRx will follow the normal process for renewals. Prior authorization requirements for medications that are newly prescribed will remain in place. If you are not utilizing OptumRx, you should contact your PBM directly.  

     
    OptumRx Specialty Medications Extended Supply Distribution

    During the COVID-19 outbreak, when a patient calls to refill their specialty medication, Optum Specialty Pharmacy will offer patients a one-time, 90-day supply of key chronic specialty medications. This policy goes into effect the week of March 23, 2020.

    Drugs within the following categories will remain limited to 30 days’ supply only:

    • Acute medications
    • Controlled substances
    • Drugs subject to REMS programming requiring 30 day dispensing and monitoring
    • Drugs with limited expiration dating
    • Drugs where storage/handling issues would increase the risk of waste
    • Office-administered injectable/infusible therapies 
    • Drugs experiencing supply shortages 
    • Drugs dosed less frequently than once monthly 
    • Drugs whose monthly ingredient cost exceeds $10,000 

     

    This policy will not auto-dispense medications in supplies >30 days without the direct consent of the patient. This policy will also not apply to patients who are newly initiated on a specialty therapy. If you are not utilizing OptumRx, you should contact your PBM directly.

     

    OptumRx Hydroxychloroquine and Chloroquine Use

    Hydroxychloroquine has recently been featured in the news as a potential treatment for moderate to severe COVID-19 illness. The use of hydroxychloroquine and chloroquine in COVID-19 is causing increased utilization and risk of drug shortage. OptumRx is implementing a quantity limit for hydroxychloroquine to preserve continued supply for chronic users with existing conditions while ensuring access for treatment of COVID-19 when appropriate. This policy goes into effect March 31, 2020. If you are not utilizing OptumRx, you should contact your PBM directly.

    • Hydroxychloroquine will be limited to 30 tablets within a 90 day time period with an automatic bypass for members who have utilized at least a 60 day supply within the past 120 days.
    • Chloroquine will be limited to 30 tablets within a 90 day time period. 
    • Members newly starting on hydroxychloroquine for rheumatoid arthritis or systemic lupus will be able to request quantities beyond 30 tablets through a manual override process.
    • OptumRx will message pharmacists at the point of dispensing to encourage filling for appropriate COVID-19 use.
  • Precertification of Testing Services

    MedCost does not require precertification on COVID-19 testing or treatment services (except in the event of a non-emergent inpatient admission).

  • Teladoc Services

    For clients with Teladoc, your members have convenient access to virtual doctor consultations. Teladoc physicians provide up-to-date, evidence-based supportive care to screen for possible COVID-19 cases and relieve symptoms for affected patients. Most cases of the virus are mild and can be safely managed via an at-home care plan. Health plan sponsors may choose to waive co-pays. 

    As the coronavirus pandemic evolves, members may experience extended wait times due to the high demand and need for Teladoc’s services. Teladoc has implemented the following strategies to address the increase in volume:

    Optimizing physician capacity: Teladoc has enhanced its technology to help doctors efficiently address COVID-19 cases and supply patients with home care information, automate suspected COVID-19 case reporting, and approve 30-day prescription refills and extend 90-day refills where appropriate. To serve escalating demand, Teladoc is rapidly onboarding more high-quality board-certified physicians and is activating its existing physician network to drive increased consult availability.

    Temporarily streamlining how people access and receive care: Teladoc is actively managing visit requests and accepting on-demand visits, scheduled visits, or both during specific periods of the day, so as best to serve peak demand. Video visit requests may be converted to phone visits for faster response. For the fastest support, members are encouraged to download the mobile app or use the website to request a doctor visit.

    For those who choose to call, Teladoc has implemented technology that enables a callback from a service representative rather than waiting on hold. And after a visit request is initiated, members are encouraged to be available and ready to promptly answer callbacks, as requests will be considered canceled after 1 unanswered callback attempt (which typically includes 3 outbound calls) by a doctor. 

    Managing member expectations and experience: Teladoc’s phone, website, and App messaging transparently shares that Teladoc is experiencing high visit volumes and provides useful information about COVID-19 while members wait to connect with a doctor. Service communications are deployed to assure waiting members that they remain in the queue and periodic outreach asks members to confirm that they still need to talk to a doctor, helping to efficiently allocate doctors’ time to active, unabandoned visits and requests.
     

Providers

As you read through the topics below, please be aware of the following terms:
MedCost, LLC refers to our entire organization.
MedCost Network in NC and SC and MedCost Virginia in VA refer to our provider networks which are leased by various payers/administrators.
MedCost Benefit Services refers to our own TPA which administers self-funded health plans sponsored by employers.

MedCost, LLC is closely monitoring the COVID-19 situation and has deployed our business continuity plan to protect the health of our employees while safeguarding our ability to perform the services our providers, clients, and health plan members rely on. Our systems are ready to accept claims related to COVID-19 testing and treatment, as well as expanded telehealth services.
 
We understand that you have questions, and the topics below are being reviewed and continually updated to provide answers as this national health emergency evolves. Please be aware that MedCost, LLC is in a unique position since we are both a leased provider network (MedCost Network in NC and SC, and MedCost Virginia in VA) and a payer/administrator for employers with self-funded health plans through our TPA, MedCost Benefit Services. 

Many of our provider partners have requested changes to existing requirements during this time. Whenever possible, we will try to accommodate those requests as they pertain to our leased networks (MedCost Network and MedCost Virginia) and our own TPA processes (MedCost Benefit Services). Some requirements are dictated by the individual health plans, over which we have no control. Also, other payers/administrators accessing MedCost Network or MedCost Virginia as leased networks will have their own procedures or policies in place. If you have specific questions, please direct them to the payer/administrator indicated on the back of the member’s ID card. MedCost, LLC will make every effort to communicate changes to our network providers via email, but this web page is your most up-to-date source for information. Please continue to check it regularly.
 

  • Business Continuity

    As an organization, MedCost, LLC is committed to maintaining a safe workplace and doing whatever we can to mitigate the spread of the virus. MedCost, LLC has a comprehensive business continuity plan that involves every aspect of our organization and contemplates how we will respond in an emergency to assure our organization is able to continue to provide normal services for our clients, providers, payers, and members. To that end, we have instituted our business continuity plan, and successfully transitioned our workforce to a remote environment, effective Monday, March 16, 2020, so that business operations may continue uninterrupted for the foreseeable future. 

    MedCost, LLC has a dedicated team reviewing all applicable local, state and national regulatory updates that may impact authorization processes and clinical procedures. Currently, there are no updates that materially change or delay our existing processes or require us to expand or limit our normal business hours.  

  • Claims Filing Deadlines

    Claims filing deadlines can vary by payer/administrator and can also be dictated by requirements within individual health plans, ranging from 90 days to 18 months. The majority of payers/administrators leasing our networks (MedCost Network and MedCost Virginia) offer a generous 180-day claims filing deadline. Plans administered by MedCost Benefit Services, our own TPA, also offer a claims filing deadline of at least 180 days. As always, MedCost Benefit Services will work closely with providers, clients and health plan members to evaluate additional flexibility and special considerations as needed during the COVID-19 health emergency. Other payers/administrators accessing MedCost Network and MedCost Virginia as leased networks will have their own procedures or policies in place. If you have specific questions, please direct them to the payer/administrator indicated on the back of the member’s ID card. 

  • Coverage for Testing and Treatment

    All medical plans for MedCost Benefit Services clients include coverage for testing and treatment of COVID-19. The Families First Coronavirus Response Act requires all group health plans and health insurers, including self-funded and grandfathered health plans under the ACA, to cover testing for COVID-19 without any cost sharing (co-pays, co-insurance, deductibles). The language of the bill does not limit this requirement to in-network services. Until we receive further guidance from the federal government, we are interpreting this requirement to apply to both in- and out-of-network services.  

    The Families First Coronavirus Response Act does not address treatment for COVID-19. However, all medical plans for MedCost Benefit Services clients include coverage for treatment of COVID-19, which is covered subject to normal cost-sharing. Health plan sponsors who choose to do so may waive applicable cost-sharing (co-pays, co-insurance, deductibles) for the treatment of COVID-19.

    The IRS has declared that HSA-eligible High Deductible Health Plans are permitted to cover COVID-19 testing and treatment before cost-sharing without impacting HSA status. 

  • Online Access

    Access to our secure provider portal is available 24/7 on MedCost.com. And, during our regular business hours of 8:30 a.m. – 5:00 p.m. ET Monday through Friday, you can call 1-800-795-1023 or access Live Chat on www.MedCost.com to get real-time answers and support from MedCost Customer Service.
     

  • Pharmacy (PBM) Services
    OptumRx Early Refill of Maintenance Medication

    For patients with OptumRx as their PBM, “refill-too-soon” edits have been lifted. Members with active eligibility may obtain an early refill of their prescription medications if they have refills remaining on file at a participating retail or mail-order pharmacy. The refill obtained will stay consistent with the standard days’ supply previously filled by the member as allowed by their plan (e.g., 30- or 90-day supply). OptumRx will continuously evaluate this change to determine the appropriate duration based on CDC guidance, Federal and State declarations, and other relevant data. If the patient’s PBM is not OptumRx, please contact the PBM listed on the patient’s ID card.

     

    OptumRx Prior Authorization (PA) Extension

    As of March 19, OptumRx is automatically extending existing prior authorizations for most chronic medications that are set to expire on or before May 1, 2020, for an additional 90 days. OptumRx will re-evaluate the need for further extensions thereafter. Drugs with significant abuse potential (i.e., opioids) or those that are generally dosed for finite durations or intermittently (i.e., hepatitis agents, fertility agents) as identified by OptumRx will follow the normal process for renewals. Prior authorization requirements for medications that are newly prescribed will remain in place. If the patient’s PBM is not OptumRx, please contact the PBM listed on the patient’s ID card.

     

    OptumRx Specialty Medications Extended Supply Distribution

    During the COVID-19 outbreak, when a patient calls to refill their specialty medication, Optum Specialty Pharmacy will offer patients a one-time, 90-day supply of key chronic specialty medications. This policy goes into effect the week of March 23, 2020.

    Drugs within the following categories will remain limited to 30 days’ supply only:

    • Acute medications
    • Controlled substances
    • Drugs subject to REMS programming requiring 30 day dispensing and monitoring
    • Drugs with limited expiration dating
    • Drugs where storage/handling issues would increase the risk of waste
    • Office-administered injectable/infusible therapies 
    • Drugs experiencing supply shortages 
    • Drugs dosed less frequently than once monthly 
    • Drugs whose monthly ingredient cost exceeds $10,000 

     

    This policy will not auto-dispense medications in supplies >30 days without the direct consent of the patient. This policy will also not apply to patients who are newly initiated on a specialty therapy. If the patient’s PBM is not OptumRx, please contact the PBM listed on the patient’s ID card.

     

    OptumRx Hydroxychloroquine and Chloroquine Use

    Hydroxychloroquine has recently been featured in the news as a potential treatment for moderate to severe COVID-19 illness. The use of hydroxychloroquine and chloroquine in COVID-19 is causing increased utilization and risk of drug shortage. OptumRx is implementing a quantity limit for hydroxychloroquine to preserve continued supply for chronic users with existing conditions while ensuring access for treatment of COVID-19 when appropriate. This policy goes into effect March 31, 2020. If the patient’s PBM is not OptumRx, please contact the PBM listed on the patient’s ID card.

    • Hydroxychloroquine will be limited to 30 tablets within a 90 day time period with an automatic bypass for members who have utilized at least a 60 day supply within the past 120 days.
    • Chloroquine will be limited to 30 tablets within a 90 day time period. 
    • Members newly starting on hydroxychloroquine for rheumatoid arthritis or systemic lupus will be able to request quantities beyond 30 tablets through a manual override process.
    • OptumRx will message pharmacists at the point of dispensing to encourage filling for appropriate COVID-19 use.
       
  • Precertification/Authorization

    MedCost, LLC is closely monitoring the impact of COVID-19 within our MedCost Network and MedCost Virginia provider communities. We will continue to evaluate the dynamic needs of our network providers and consider any shifts in processes beneficial to meet the healthcare needs of the population. At this time, our standard business requirements for services and supplies remain in place.

    Testing/Treatment

    MedCost Benefit Services does not require precertification on COVID-19 testing or treatment services (except in the event of a non-emergent inpatient admission). Other payers/administrators accessing MedCost Network and MedCost Virginia as leased networks will have their own precertification/authorization procedures or policies in place. If you have specific questions, please direct them to the payer/administrator indicated on the back of the member’s ID card. 

    Inpatient Admission (Non-Emergent)

    At this time, authorization requirements remain in place per MedCost Benefit Services standard business requirements. Hospital-to-hospital inpatient care transfers do not require authorization and would be reimbursed at the benefit specifications of the health plan. Note: Non-Emergent Air Transport does require prior authorization. Authorizations are valid for up to 6 months from the date issued. Beyond 6 months, a new authorization request would need to be made. Other payers/administrators accessing MedCost Network and MedCost Virginia as leased networks will have their own inpatient authorization procedures or policies in place. If you have specific questions, please direct them to the payer/administrator indicated on the back of the member’s ID card. 

  • Telehealth

    It is up to the plan sponsor (employer or insurance carrier) to elect to cover telehealth visits (COVID-19 and non-COVID-19) under their health plan and also whether to waive applicable cost-sharing (co-pays, co-insurance, deductibles). To verify coverage and/or any applicable cost sharing for telehealth services or for other specific questions, please contact the payer/administrator indicated on the back of the member’s ID card.

    Filing a Telehealth Claim

    MedCost Network and MedCost Virginia have allowables established for telehealth services. To ensure accurate pricing and payment consideration, telehealth claims should be filed using POS 02 following standard CPT and HCPCS coding guidelines, including coding based on time. Appended modifiers of CR and 95 for telehealth claims are accepted if filed, but not required. For COVID-19 related services, please ensure your claim is filed with the appropriate COVID-19 diagnosis code(s).

     

What is COVID-19?

COVID-19 is a respiratory illness that can spread from person to person. The virus is thought to spread mainly between people who are in close contact with one another (within about 6 feet) through respiratory droplets produced when an infected person coughs or sneezes. It also may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes. Mild or severe symptoms may include fever, cough and/or shortness of breath.