Sendero Health Plans becomes first Austin area affordable care act health plan to waive cost-sharing for COVID-19 treatment

PR Newswire

AUSTIN, Texas, April 1, 2020 /PRNewswire/ -- Sendero Health Plans, the community-based non-profit health maintenance organization serving the Austin-area, announced today that the company's Board of Directors voted to waive all costs to its members for treatment of COVID-19 with in-network providers.

The move makes Sendero the first area affordable care act health plan to waive cost-sharing for treatment and comes as the company also recently waived copayments for in-network doctor visits and lab costs to screen for the disease.

"As a community health plan, Sendero does everything we can to ensure our members get the quality care they need," said Wesley Durkalski, president and CEO of Sendero Health Plans. "We have eliminated cost sharing for COVID-19 testing and treatment and are working with members with income changes to help them stay covered. We are helping our members get connected with resources we have, not just for care but for all basic daily needs. We are very happy to offer this to members at a time when there is significant stress over not just household physical and mental health, but household financial health as well."

In early March, Sendero redeployed staff to conduct outreach calls to over 10 percent of its membership, including all members most at risk of being impacted by this crisis. This included more than 500 low income, high acuity, former uninsured in Central Health's Medical Access Program (MAP) members now insured with Sendero. Calls emphasized personal safety, Sendero's extensive telehealth services and ensuring member access to resources for basic needs.

Sendero has taken other specific steps in addition to eliminating costs for detection and treatment to assist its members and work with its provider network in response to the COVID-19 crisis including:

Providing free prescription delivery through larger pharmacies.
Allowing early refills for maintenance medications.
Extending provider claims submission deadlines.
Working with providers to expand telemedicine and help ensure capacity for care.

"We want our members to focus on the health and well-being of themselves and their families and know that their community health plan is here to help," said Durkalski. "We are dedicated to keeping our members and their families healthy."

Health care coverage typically includes member cost sharing which are costs directly paid by member to help lower the monthly costs of premium. This includes copays, deductibles, and cost sharing. Copays are fixed amounts that members pay to providers in addition to amounts paid by the insurer. Deductibles are certain dollar amounts for care that must be paid by the customer first before the insurer can assume payment. Cost sharing is a split of provider costs between the insurance company and the customer and can represent 70 percent / 30 percent with the insurance company paying the larger portion of health care costs until an annual maximum is reached for the member.

Sendero's move eliminates the aforementioned costs for its members for the treatment of COVID-19 and will remain in place until further notice.

Formed in 2011, Sendero Health Plans, Inc. is a community-based nonprofit Health Maintenance Organization supported by the Travis County Health District, known as Central Health, dedicated to improving the health of the community by providing affordable, quality healthcare coverage, especially for Travis County residents with low income. Sendero offers its IdealCare and SelectCare plans on the Federal Health Insurance Marketplace.