Pennsylvania Insurance Department Issues Guidance to Insurers for Consumer Protection, Calls for Clarity in Telehealth Policies

Pennsylvania Insurance Commissioner Jessica Altman announced that the Department of Insurance has issued guidance on health insurance-related services to protect consumers, and to call for clarity in insurers’ telehealth policies during the ongoing COVID-19 pandemic. A notice, which was included in the March 6 Pennsylvania Bulletin, outlines expectations regarding coverage by insurers of testing and vaccine administration to Pennsylvanians, and urges continued telehealth flexibility to make both COVID-related services and non-COVID-related services available to consumers.

“As we continue our fight against COVID-19, it is vital to make sure all Pennsylvanians have access to the resources needed to combat this public health crisis, and that includes testing and vaccination options,” Commissioner Altman said. “Health insurers play a critical role in access and affordability of these services and should ensure that most consumers can access these services at no cost to the consumers. The carriers have been an important partner in the commonwealth’s response to COVID, and we look forward to that continued partnership as we forge through the next stages of our pandemic response.”

The notice highlights the expectation that insurers will continue to cover COVID testing and vaccination without cost-sharing as required under The Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The notice also calls for health insurers to assist consumers in accessing in-network or publicly funded health services to avoid balance billing or surprise balance bills. Mechanisms should already be in place to prevent surprise balance billing for COVID-related services, but the department urges insurers to take steps now to make necessary changes to billing services in anticipation of the No Surprises Act, taking effect in 2022.

The notice also calls for clarity and consistency in insurers’ telehealth policies across the commonwealth while the COVID-19 health emergency is ongoing. A previous notice encouraged health insurers to allow for flexibility in telehealth services, and many insurers implemented flexibilities in their policies and coverage of telehealth services, some permanently. However, different approaches and timelines has caused confusion for both providers and consumers.

“We appreciate the insurers that have made an effort to expand access to telehealth services during the pandemic, allowing for continued routine and urgent health care for the duration of the public health emergency,” said Altman. “The department is now encouraging insurers to implement consistency in these policy flexibilities, most particularly by aligning policies with emergency declaration dates and offering network flexibility for providers that offer both telehealth and in-person services.”

The department notice encourages telehealth policy flexibilities to be extended through the end of the federal or Pennsylvania public health emergency and suggests a 60-day wind-down period for flexibilities to provide for an orderly transition for both providers and patients.

“As we enter the second year of the COVID-19 pandemic and the situation continues to evolve, we ask insurers for their continued readiness to make any necessary changes in policy to address the crisis head on,” added Altman. “We appreciate the commonwealth-wide response we have seen thus far in providing coverage and care for all Pennsylvanians.”

The department has submitted various notices to the Pennsylvania Bulletin to help ease the hardships that are being felt by Pennsylvanians during this crisis and ensure minimum disruption to the department and commonwealth-regulated operations.

If a consumer receives an unexpected bill related to COVID-19, or other healthcare services, they are encouraged to contact the department at 1-877-881-6388.