Highmark and the Covid-19 Epidemic

COVID-19 has forced everyone in health care to think differently about how we live our lives. Highmark continues to closely monitor the COVID-19 outbreak across the nation and in the communities we serve. As a result of these unprecedented circumstances, we have implemented a response plan to ensure that we are doing all we can to meet the health needs of our members while safeguarding our participating physicians, caregivers and employees. To do this we are:

  • Covering certain member services
  • Implementing Administrative services
  • Implementing Telehealth and Virtual Visit changes.


Member Coverage

Inpatient Services
Highmark waived out-of-pocket costs for COVID-19 related inpatient hospitalization following a COVID-19 diagnosis. Members who require in-network, inpatient hospital care for COVID-19 will not incur any deductibles, co-insurance and co-pays, effective immediately. The decision applies to members with group employer coverage (self-funded groups may elect to opt into the program), as well as ACA and Medicare members.

“Our number one priority — especially during this crisis — is to make sure that our members receive the care that they need,” said Deborah Rice-Johnson, president of Highmark Inc. “With this decision, we are removing potential barriers our members may face in receiving care for COVID-19. It is the right thing to do for our members and for our community.”

The waiver will continue through May 31 as Highmark continues to monitor and evaluate the rapidly changing nature of this crisis.

Outpatient Services
Highmark has also waived the member cost share for office visits (including telehealth), urgent care visits, and Emergency Department visits when the visit results in a COVID-19 test being ordered or administered. In addition, Highmark will waive member cost share for any items or services provided during the visit in which the COVID-19 test is ordered or administered (items or services unrelated to the evaluation of whether a patient should be tested for COVID-19 will be paid based on the member’s benefit plan).

Virtual Visits and Telemedicine
To help ensure members can continue to safely receive care, Highmark has also expanded access to telehealth services for all members and has waived out-of-pocket costs such as deductibles, coinsurance, and copayments on all covered telehealth services from contracted vendors and providers through June 13, 2020.

“During this crisis, telehealth is an option for members to safely receive care without going to a doctor's office or hospital and risking exposure,” said Rice-Johnson. “Using telemedicine also frees up medical facilities to treat those who are most in need of care, which is vitally important as the virus continues to spread.”

Alongside this initiative, Highmark has expanded access to teleaddiction services for members in PA, WV, and DE who are in addiction treatment and need immediate help without any out-of-pocket costs through our provider partner, Bright Heart Health (see page X of the newsletter).

Administrative Changes

Highmark has strived to lessen the administrative burden on providers by temporarily adjusting various policies to ensure that providers can focus on delivering efficient and effective care to their patients/our members.
Examples include:

  • Prior authorizations for certain procedures have been extended during this time to avoid the need for a second authorization
  • An expedited credentialing process to ensure members have timely access to care during unprecedented burden on health systems and practices
  • Extended timely filing to an entire year for in-network providers from February 1 through June 30, 2020 during regardless;
  • And many others.

Please see the COVID-19 Clinical/Operational Update page on Highmark’s Provider Resource Center for more information.

Telemedicine/Virtual Visit Changes

As part of the COVID-19 response, lawmakers have focused on lifting possible barriers to the use of telemedicine  -  like rules that limited coverage and regulations that banned the use of apps like FaceTime and Skype. In alignment, Highmark greatly expanded the types of services that are covered via telemedicine and relaxed the technology standards in our policies for providing telemedicine. By doing so, Highmark is attempting to make it easier to provide services, eliminate some administrative costs, and potentially avoid the need for investment in technology.

To locate the expanded code list, or for more information on what Highmark is doing during this crisis, review the COVID-19 pages on the Provider Resource center.

Thank you for your efforts to ensure that our members have continued access to quality health care despite the challenging circumstances brought on by COVID-19. You are critical to our shared success in meeting the health care needs of the community.