File a Complaint

Yes. On March 5, 2020, Insurance Commissioner Ricardo Lara released a COVID-19 Screening and Testing Bulletin1 directing health insurers to waive cost sharing amounts for certain COVID19 related screening and testing. Since that date, two federal laws were passed, which require coverage for COVID-19 related diagnostic testing and screening, without patient cost sharing, including deductibles, coinsurance, and copays. Section 6001 of the federal Families First Coronavirus Response Act (FFCRA) (PL 116-127) § 6001, as amended by § 3201 of the federal Coronavirus Aid, Relief, and Economic Security Act (CARES Act) (PL 116-136),2 applies to a “group health plan,” including insured3 and selfinsured group health plans, private employment-based group health plans (ERISA plans), nonfederal governmental plans, and church plans.4 It also applies to “individual health insurance

No. Health insurers have a legal obligation to promptly pay claims. Insurance Code §§ 10123.13 and 10123.147 require insurers to pay claims as soon as possible but no later than 30 working days after receipt of a complete claim, unless the insurer notifies the provider in writing that the claim has been denied or is being contested. Insurers must pay interest on a completed claim if the claim has not been reimbursed, contested or denied within the 30 working-day deadline.11 Failure to comply with the claims handling deadlines in state law may also be considered an unfair claims settlement practice under Insurance Code § 790.03(h). Providers should contact the Department’s Provider Complaint Center if a health insurer is not paying claims in compliance with these deadlines.