Healthcare Providers
Over-the-Counter Tests
Effective May 12, 2023, we will no longer cover over-the-counter tests unless a self-insured group decides to continue to cover them.
Costs Being Waived for Fully Insured Members
Effective May 12, 2023 benefits revert to benefits stipulated in the member’s contract and cost sharing is no longer waived.
This information is for historical information:
Throughout the pandemic, CareFirst has enhanced our benefits to ensure members can get the care they need. These enhancements include covering services not previously covered and waiving fully insured* member costs for select services related to COVID-19.
We will continue to track the situation to make sure our benefits are appropriate and update as necessary. Prior notice will be given before ending any benefit enhancements.
View this chart for details on the benefit changes we’ve made. Providers are encouraged not to collect member cost sharing for these services. If a member does owe a copay or coinsurance after the claim is processed, you can bill the member as you do for all other claims.
*We are also partnering closely with our self-insured customers to implement similar measures.
For CareFirst BlueCross BlueShield and CareFirst BlueChoice Members
|
Deductibles, Copays and Coinsurance | |||
|---|---|---|---|
| Service | Cost Share Waiver must be related to COVID-19? | In-Network | Out-of-Network |
| Diagnostic Test for COVID-19 | YES | Waive member liability for deductibles, copays and coinsurance |
CareFirst/Plan Sponsor pays 100% up to charge (no balance billing) |
| FDA-Authorized Antibody (Blood) Test for COVID-19 | YES | Waive member liability for deductibles, copays and coinsurance |
CareFirst/Plan Sponsor pays 100% up to charge (no balance billing) |
| Visits (regardless of setting) associated with Diagnostic Testing | YES | Waive member liability for deductibles, copays and coinsurance | CareFirst/Plan Sponsor pays 100% up to our allowed amount, but member can be balance billed |
|
FDA Emergency Use Authorized or Approved COVID-19 Vaccines |
YES |
Waive member liability for deductibles, copays and coinsurance for administration of vaccines and associated office visit Cost of vaccine is covered by the federal government |
CareFirst/Plan Sponsor pays 100% up to charge for administration of vaccines and associated office visit (no balance billing) |
|
Monoclonal Antibody Infusion |
YES | Waive member liability for deductibles, copays and coinsurance |
CareFirst/Plan Sponsor pays 100% up to our allowed amount, but member can be balance billed |
|
Oral Antiviral Pills for COVID-19 |
YES | Waive member liability for deductibles, copays and coinsurance |
CareFirst/Plan Sponsor pays 100% up to charge (no balance billing) |
CareFirst covers, with no cost share to the member (including our members enrolled in high deductible health plans), the appropriate diagnostic testing for COVID-19. CareFirst does not provide benefits for COVID-19 testing for surveillance, work or social purposes. This policy will apply to all CareFirst members except where testing for surveillance, work or social purposes is required by law.