Read more about benefit policies to aid victims
National Reports-Health plans continue to modify medical and pharmacy benefit policies to serve members affected in the Gulf Coast region. Those adjustments range from allowing those members to have access to any provider, even if that provider is out-of-network, to suspending medication refill limits.
"This is unprecedented and very much needed," according to Christopher Valerian, DO, MMM (Master of Medical Management), executive medical director, quality and clinical innovations at Horizon Blue Cross Blue Shield of New Jersey. Valerian experienced the devastation first-hand when he was deployed to New Orleans on a 10-day mission as medical manager for New Jersey Task Force One (NJ-TF1), an urban search and rescue task force. "The people there have no idea where their next meal is coming from-never mind what their health coverage allows them to do. I spoke with people there who have only the clothes on their backs."
Blue Cross and Blue Shield of Louisiana (BCBSLA) in Baton Rouge is reaching out in a number of ways to make it easier for its members and providers in the hardest-hit areas to receive healthcare.
BCBSLA also has made arrangements with its pharmacy benefit manager Express Scripts Inc., to allow customers statewide to refill their prescriptions early, assuming they have refills available. "Customers who have lost their medication or had to leave it behind should be able to simply refill the prescription, even if 30 days have not passed since their last refill," Maginnis says.
BCBSLA also is offering assistance to providers who are seeing a patient for the first time because they are displaced by the storm. If the patient does not know the medications he or she is taking, the provider can call Express Scripts toll-free for help in identifying the most recent medications filled by the patient.
"We're also reaching out to providers in the affected areas who are unable to receive mail at their regular addresses," Maginnis says. "We are working with them to set up Electronic Funds Transfer [EFT] payment arrangements or to send their reimbursement checks and other correspondence to an alternate address."
BCBSLA is working with agents and brokers in similar ways-finding alternate ways to get them commission checks, for example, and offering the assistance of its Broker Service Center to help them answer their customer's questions.
"We are being flexible with our members, providers and pharmacies in those [affected] areas, and for our members who had to leave the state," according to Blue Cross & Blue Shield of Mississippi (BCBSMS) spokesman John Sewell. BCBSMS in Jackson estimates that about 25% of its members were affected by the hurricane.
CIGNA has 160,000 to 175,000 members in the affected Gulf areas of Louisiana, Mississippi and Alabama. Additionally, it believes that approximately 600 of its group life, accident and disability insureds might have been affected.
"Many people who are insured by CIGNA have been displaced and will be seeking care out of their network areas," according to Gloria Barone, spokesperson for CIGNA Corp. "In order for members to more easily access medical care and services, we have temporarily modified certain standard claim approval requirements, including requirements for precertification, referrals, medical necessity determinations and hospital admission procedures."
The grace period for receipt of premium payment by affected CIGNA customers has been extended for a total of 61 days, to help offset business challenges caused by the disaster, according to Barone. CIGNA Group Insurance also will allow an appropriate extension of time for making premium payments for life, accident and disability coverage, and for certain other time-sensitive policy transactions, such as receipt of medical information and conversion requests for certificate holders in the affected areas.
According to Barone, CIGNA Behavioral Health has expanded its telephone helpline to help those affected by the hurricane cope with disaster-related stress. In addition, CIGNA Pharmacy Management will allow members to order refills of their prescription medications early to replace medicines lost or destroyed, and will waive medical necessity reviews.