Long COVID’ Presents Big Challenges for Health Plans, Patients

by Leslie Small

 

As the country continues to grapple with the COVID-19 pandemic, the issue of “long COVID” is becoming increasingly visible — posing thorny challenges not only for the patients suffering from it but also health care providers, payers and policymakers alike.

 

Long-haul Patients Struggle to Get Coverage 

• Over half of COVID-19 patients have experienced long COVID six months after recovery, according to one recent study.  
• In addition to the often-debilitating symptoms associated with long COVID, patients with this condition may face the added burden of struggling to get their treatment covered, according to an Oct. 18 blog post by the Georgetown University Center on Health Insurance Reforms. Karen Davenport, the author of the post, tells AIS Health that there isn’t yet any reliable data about insurance denials for long COVID care, but “there certainly have been stories about people who have been denied payment for services associated with long COVID.” 
• Long COVID patients may receive physical, respiratory or occupational therapy to treat problems such as fatigue, shortness of breath or cognitive issues, but many health plans restrict coverage for these therapies to a set number of visits or will only cover therapy services as long as the patient continues to improve. That can leave patients with large out-of-pocket costs. 
• “Frankly, for health plans, I think they’re dealing with the same thing that physicians and physical therapists and everybody else are, which is…we don’t know that much about post-COVID conditions, we don’t know that much about treatment for them. There’s just a lot of uncertainty,” Davenport says.  

What Efforts Could Ease the Burden? 

• One step that can help is the availability of a new ICD-10 code that clinicians and insurers can use for long COVID, Davenport points out. “Providers can also use this code to indicate the relationship of a previous COVID infection to the current diagnosis, which may simplify some payment disputes.” 
• When asked what else private payers could do, Davenport says one critical step is simply to be “aware that these claims are coming through and that some of their regular systems might automatically deny them.” 
• On the regulatory front, Davenport says policymakers could require payers to cover patients’ out-of-pocket costs for certain services. And she suggests that self-funded employers could encourage insurers to set up dedicated networks around post-COVID care. 

From Health Plan Weekly