MedCost 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. MedCost is in a unique position since we are both a leased network and a payer for self-funded clients. Other payers accessing MedCost as a leased network will have their own procedures or policies in place. If you have specific questions, please direct them to the payer indicated on the back of the member’s ID card. As a payer, we are working with MedCost Benefit Services employer groups to offer the following options:
Coverage for Testing and Treatment
All medical plans for MedCost Benefit Services clients include coverage for testing and treatment (in-office and, if covered, virtual) of COVID-19, which is covered subject to normal cost-sharing. To remove barriers for members seeking care, employers may waive applicable cost-sharing (co-pays, co-insurance, deductibles) for testing and/or treatment of COVID-19. The IRS has declared that HSA-eligible High Deductible Health Plans also are permitted to cover coronavirus testing and treatment before cost-sharing without impacting HSA status. We have offered this plan option to our clients and will work with them on an individual basis to quickly implement if they so choose.
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).
Telehealth
MedCost already has allowables established for telehealth services. If an appropriate CPT code is filed according to the guidelines outlined in the MedCost Provider Manual, the claim will be repriced in accordance with your contract. Please ensure the claim includes the appropriate COVID-19 related diagnosis.
Pharmacy (PBM) Services
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.
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, 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.
As an organization, MedCost is committed to maintaining a safe workplace. We have implemented a work from home policy effective Monday, March 16, 2020, and have travel restrictions in place. As always, MedCost will work closely with our provider partners, clients and health plan members to offer additional flexibility and special considerations as needed.