Payment Reimbursement and Managed Care

Some health plans accelerate hospital payments to provide COVID-19 financial help

April 14, 2020 1:04 pm
  • A small but increasing number of health plans are offering accelerated payments or cash advances to help stabilize hospitals during the COVID-19 pandemic.
  • Many health plans are covering cost-sharing for COVID-19 testing and treatment.
  • Calls to ease administrative burdens have elicited a range of policy changes from health plans.

Some health plans have agreed to hospital requests to accelerate the processing of payments by weeks or months in response to the financial challenges brought on by the coronavirus.

UnitedHealth Group recently announced it will accelerate nearly $2 billion in provider payments from its fully insured commercial, Medicare Advantage and Medicaid plans.

“Many health systems are having to make very difficult decisions due to the cost of preparing and responding to COVID-19 plus the reduction or elimination of elective procedures, so steps like this will meaningfully mitigate the need to make some of these decisions,” Sam Hazen, CEO of HCA Healthcare, said in a release.

Other instances in which health plans are offering accelerated or advance payments include:

  • Cash advances from CareFirst BlueCross BlueShield to hospitals demonstrating need in Maryland, Washington, D.C., and Northern Virginia
  • Financing guarantees, advance payments and restructuring of contracts by Blue Shield of California
  • Expedited hospital payments from EmblemHealth, which serves New York, New Jersey and Connecticut

Physician assistance provided

Some health plans have directed advance or accelerated payments to physician practices. Those include:

  • Accelerated payments from Blue Cross Blue Shield of Michigan to practices to support their efforts to treat patients with COVID-19
  • Advance payments through June from Blue Cross of Idaho for independent providers, such as private-practice physician groups, to cover monetary shortfalls due to COVID-19
  • Advances on payments that had been scheduled for June from Highmark for more than 1,700 primary care practices in its True  performance payment program
  • Advance payments by Premera Blue Cross for medical, dental and behavioral healthcare providers facing significant financial pressures due to COVID-19

More steps sought

UnitedHealth Group’s  April 7 action on accelerated payments came a week after the American Hospital Association (AHA) sent a letter to the five largest health plans and two national associations urging payment acceleration and other steps to help hospitals financially survive the challenges stemming from the virus.

AHA also sought the following measures:

  • Eliminating administrative processes, such as prior authorization and certain payment edits
  • Providing “adequate” payment for such care
  • Covering cost-sharing for COVID-19 treatment

Many health plans have offered to cover costs, including out-of-pocket costs, of COVID-19 testing and treatment. For instance, Blue Cross Blue Shield Association (BCBSA) announced April 2 that through May 31, its member companies will waive cost-sharing for treatment of COVID-19, including for inpatient hospital stays. The health plans will pay providers at either in-network or Medicare rates per state regulations.

Aetna has waived out-of-pocket costs of commercial plan and Medicare Advantage enrollees for COVID-19 treatment at both in-network and out-of-network facilities.

Health plans have been a little more scattershot in their response to provider requests for reduced administrative burdens.

One of the most responsive plans has been Blue Cross Blue Shield of Massachusetts, which replaced prior authorization requirements with a notification-only requirement for inpatient levels of care, including those at acute care facilities, long-term acute care facilities, acute and subacute rehabilitation facilities and skilled nursing facilities.

The health plan also suspended medical necessity reviews for such care through June 23.

Other efforts to ease administrative burdens amid the pandemic include:

  • Cigna is waiving requirements for prior authorization of transfers of non-COVID-19 customers from acute inpatient hospitals to in-network long-term acute care hospitals.
  • EmblemHealth is waiving prior authorization and concurrent review for all inpatient admissions.
  • Humana is suspending prior authorization and referral requirements and instead requesting notification within 24 hours of inpatient acute and post-acute care and outpatient care.


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