Novel Coronavirus (COVID-19) Remote Doctor Visits

 VHP (Telehealth) Policy and Recommendations during the Coronavirus (COVID-19) Health Emergency

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To All Our VHP Members:

As California responds to the Coronavirus (COVID-19) public health emergency, Valley Health Plan (VHP) encourages its members to access health care through remote doctor   visits using either telephone or video. Remote doctor visits can help people get care faster and reduce the spread of the Coronavirus. Getting care by phone or video conferencing, might not be appropriate in all cases. Please talk to your doctor about whether a remote visit is appropriate for you.

Medical Privacy

In support of the critical role that remote care can play in limiting the spread of the Coronavirus (COVID-19) the Health and Human Services’ Office for Civil Rights (OCR) issued new guidance to Providers. Effective immediately, doctors and other Providers may use everyday communications technologies, such as FaceTime or Skype, Zoom or other video platforms to help their patients receive remote care when appropriate.

Your doctor will request your consent to provide care through a remote visit. This consent can be verbal, and does not need to be in writing.

Nurse Advice Line

Our 24/7 Nurse Advice Line is available at no cost to VHP members and is an excellent resource. Members can use the 24/7 Nurse Line for questions about where they should seek medical care and appropriate next steps based on your symptoms. Please use the 24/7 Nurse Advice Line for your specific plan listed below:

Employer Group Classic and Preferred Plans: 1.866.682.9492​ (toll-free)

Covered California and Individual & Family Plans: 1.855.348.9119 (toll-free)

Medi-Cal Managed Care - VHP Network: 1.877.509.0294 (toll-free)​

 

Information About At-Home OTC COVID-19 Tests and Reimbursements

Starting on January 15th, 2022, under guidance of the Biden administration, members are now eligible for at-home over-the-counter (OTC) COVID-19 tests. As described in more detail below, OTC COVID-19 tests can be (1) obtained at no cost through retail pharmacies and health centers approved by VHP, and (2) purchased by you through pharmacies, stores, or online retailers, with your cost reimbursed by VHP after you submit a claim for reimbursement.

Below are the steps each member should take to receive zero out-of-pocket cost OTC COVID-19 tests, or to request reimbursement for approved OTC COVID-19 tests. We encourage members to take advantage of our zero out-of-pocket cost OTC COVID-19 tests available through approved retail pharmacies and approved Health Centers, as this option does not require members to submit claims for reimbursement.

Note: You are entitled to eight (8) individual OTC COVID-19 tests per 30-day period under this federal program. Additional tests are only payable by VHP if they are ordered by a Provider.

Zero Out-of-Pocket Cost OTC COVID-19 Tests:

There are two ways of receiving an OTC COVID-19 test without having to pay out-of-pocket costs up front.

Option 1: Visit Approved In-Network Retail Pharmacies

1. Check for availability and visit a retail pharmacy to find an OTC COVID-19 test. You can find our in-network retail pharmacies through a “Pharmacy Network Search”: https://www.valleyhealthplan.org/sites/g/files/exjcpb771/files/documents/M-NavitusParticipatingPharmaciesNetworkListing-01012022-Final-Covid-Test-Kits.pdf

2. If in stock, and after finding the OTC COVID-19 test at the in-network retail pharmacy, ask the pharmacist to process the purchase of the test through Navitus, VHP’s pharmacy benefit administrator.

3. If the in-network retail pharmacy is out of at-home tests, see if they are available at approved health centers by following the procedure below.

4. If you need help, or if in-network retail pharmacies are out of stock, please contact Member Services.

Option 2: Visit Approved Health Centers

1. Check this link to locate qualified  health centers near you to pick up a zero out-of-pocket cost OTC COVID-19 test : https://www.hhs.gov/coronavirus/community-based-testing-sites/index.html

2. Once you locate a nearby approved health center, please check availability of the test. If available, please pick up your test.

3. If approved health centers are out of stock, please review the information under “Visit Approved Retail Pharmacies.” You can also look at the information under the “Direct Member Reimbursement Options” for reimbursement options for purchase of tests from another pharmacy, store, or online retailer.

4. If you need help, or if approved health centers are out of stock, please contact Member Services.

Direct Member Reimbursement of OTC COVID-19 Tests:

If you might want to purchase an OTC COVID-19 test and request reimbursement, please review and follow the process prior to your purchase:

1. Purchase an FDA approved OTC COVID-19 included in the list below: https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/in-vitro-diagnostics-euas-antigen-diagnostic-tests-sars-cov-2\

2. If you purchased an approved OTC COVID-19 test, please fill out the reimbursement form provided here: Microsoft Word - Prescription Drug Claim Form - DMR - 100112 (valleyhealthplan.org)

3. If your reimbursement claim is approved, your purchase cost will be reviewed for reimbursement according to federal requirements, up to a limit of 8 individual OTC COVID-19 tests for every 30-day period starting on January 15th, 2022.

For other questions about zero-cost or reimbursed OTC COVID-19 tests, please contact Member Services at 1.888.421.8444 or by emailing [email protected].

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