Insurance lobbying group America’s Health Insurance Plans (AHIP) urged insurers to offer a grace period for any pre-authorized surgeries and procedures canceled due to COVID-19.
AHIP released on Wednesday a list of core principles for insurers to follow as health systems start to resume elective procedures canceled in mid-March because of the pandemic. The principles also focus on how to ensure preventive care is provided too.
One of the principles is to implement a grace period to ensure any approval of a surgery or procedure since March 13 would continue to apply.
“These grace periods will enable surgeries and procedures to be scheduled and performed without having to be re-authorized,” a release from AHIP said. “Because circumstances will vary significantly by geography based on the incidence of COVID-19 and the availability of clinical resources, we encourage approvals to be valid for at least 90 days or until local backlogs are cleared.”
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Insurers should also encourage their customers to get any preventive or routine care deferred due to COVID-19. These preventive measures could include vaccinations, wellness visits or screenings.
Dental care should also be resumed.
AHIP also gave a nod to the explosion in the use of telehealth by providers.
The Centers for Medicare & Medicaid Services gave flexibility to providers to adopt telehealth in March, but buy-in from commercial payers has been a question mark.
AHIP said that insurers are committed to partnering with providers to continue the accelerated adoption of telehealth.
The group also noted that the industry will continue to enhance the capacity of the healthcare system to address future issues with COVID-19 or other threats to public health “while protecting our nation’s front-line healthcare heroes with adequate medical supplies, especially [personal protective equipment].”
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Another key principle is to streamline administrative processes such as prior authorization.
Providers have frequently complained that it takes too long to get approval for prior authorization of prescriptions and procedures from the insurer.
AHIP said that as other procedures and care restarts, payers will continue to try and streamline prior authorization via automation and electronic information exchange.
Some major healthcare systems such as CommonSpirit Health have started to resume elective procedures. Some systems have instituted major guidelines for how to safely restart procedures.