1. How can I find the latest information from Clover Health on the steps they have taken to address the COVID-19 outbreak?

We highly encourage providers to visit our Navinet landing page or the Clover Health provider website for the most up-to-date information on the steps we’ve taken around COVID-19.

 

2. Does Clover Health cover telehealth and telemedicine visits during the COVID-19 outbreak?

Yes! We are encouraging all providers, where appropriate, to leverage telehealth and telemedicine services in order to limit patient exposure to COVID-19. For more information, please see our expanded telehealth access policy.

3. What has Clover Health done to help increase access to COVID-19 tests? 

Clover Health has partnered with Quest Diagnostic, LabCorp and Bioreference Lab to offer our members access to some of the first commercially available COVID-19 lab tests in the United States. We will also cover COVID-19 testing if performed by another lab during this outbreak.

 

4. What has Clover Health done to limit out-of-pocket expenses to members seeking treatment and testing for COVID-19?

We have waived copays and member cost-shares for the following services:

• All telehealth and telemedicine appointments
• COVID-19 diagnostic lab testing
• Any in-network or out-of-network emergency room visits, office visits, or urgent care center visits when the purpose of the visit is to be tested for COVID-19. If a member’s symptoms are severe enough to require hospitalization, standard Clover Health inpatient coverage will apply.

 

5. What steps has Clover Health taken to ensure member access to prescriptions during the COVID-19 outbreak?

Please consider updating your patients’ prescriptions to 100-day supplies and mail-order service to further minimize their risk of exposure to COVID-19. For more information on the steps that you can take alongside Clover Health to ensure member access to prescriptions, please see this letter to providers.

 

6. Does Clover Health require a 3-day hospital stay prior to admission into a Skilled Nursing Facility?

We have never enforced the 3-day hospital stay limitation and will continue this policy during the COVID-19 outbreak.

 

7. Can a member fulfill a DME item above their standard 30 day supply?

Yes, we have worked with Integra to ensure that members serviced through their network are able to obtain their critical DME supplies in quantities larger than the standard 30-day supply.

 

8. Has Clover Health made any procedural changes around prior authorizations?

Throughout the COVID-19 pandemic, Clover did implement short term prior authorization waivers. To view all of the UM exceptions granted to date and the periods of time those exceptions were granted please review the policy updates posted here.

9. Does Clover Health plan to apply waivers to timeliness requirements around claim and claim disputes/appeal submissions?

We continue to uphold our standard process around claim submissions, claim disputes, and appeals. We also continue to closely monitor the situation. If any changes are made in the future, these updates will be documented in the above-referenced resources.

 

10. Has Clover Health waived referral requirements for HMO Members?

We do not require referrals for our HMO membership; therefore, no changes need to occur during COVID-19 around referral requirements.

 

11. Will Clover Health reimburse out-of-network facilities that service Clover Health members during this COVID-19 outbreak?

Yes! We already reimburse out-of-network facilities that service our PPO members and we will continue to do so throughout this outbreak.

 

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