OIC Issues Emergency Order Providing Balance Billing Protections for Out-of-Network COVID-19 Lab Fees

June 3, 2020

Monday, Insurance Commissioner Mike Kreidler issued an emergency order extending consumer protections from surprise bills to out-of-network lab fees for COVID-19 testing.  The order, effective June 1 through July 31, applies to both in-state and out-of-state laboratories when a provider orders diagnostic testing for COVID-19.

Under Section 3202 of the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act, insurers must reimburse laboratories the full amount they have negotiated for diagnostic services or in the case of an out-of-network lab, the lab’s cash price.  The lab is required to publish its cash price for COVID-19 testing on its website.  Providers, including labs, are generally prohibited from balance billing for COVID-19 related services by the terms and conditions for accepting CARES Act funding. OIC’s full announcement is on OIC’s website.

On a related note, the Commissioner has also extended its original COVID-related emergency order that had been due to expire today for another 30 days.The emergency order requires state-regulated insurers to cover COVID testing without application of deductible or cost-sharing, provide a one-time refill of prescription medications in advance of normal refill date upon request, and suspend prior authorization for COVID-19 testing and treatment.  OIC’s full announcement is here.  (Andrew Busz, andrewb@wsha.org)


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