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SFHSS reviews COVID-19 testing trends, claims suppression and dental PPE; plans outline member guidance
Summary
Consultants and plan representatives briefed the SFHSS board on rising cases, reduced claims from deferred care, testing prioritization for symptomatic and high-risk groups, and dental PPE policies; Kaiser announced a transportation benefit enhancement and Delta Dental described a $10 PPE reimbursement for in-network providers.
Consultants from Aon and health-plan representatives briefed the San Francisco Health Service System board on Aug. 13 about COVID-19 trends, testing access, plan-level claims data and provider guidance.
Anne Thompson of Aon opened the presentation with national, state and San Francisco data, noting case and testing counts were updated through Aug. 11-12 and that local data are a "moving target." She reported San Francisco had a seven-day average of about 3,122 tests (as of July 30) and remained at a high-alert level by per-capita case metrics.
Aon and plan actuaries described "claim suppression," the observed drop in utilization after shelter-in-place orders, and said some deferred care may return in the second half of 2020. "This is referred to as claim suppression," Aon explained, and presenters said the decline affects medical, dental and vision plans differently.
On testing access, presenters and Executive Director Yant urged members to seek tests through their provider when symptomatic and to reserve CityTest SF resources for high-priority cases (first responders, health-care workers and nursing-home outbreaks). Panelists cautioned members against responding to unsolicited calls that request payment or credit-card information for testing.
Dental PPE: Aon noted reports that out-of-network dentists have charged members $10 to $25 per visit for additional PPE; Delta Dental—s account manager, Sharon Staneklo, said Delta reimburses contracted PPO and Premier dentists $10 for specified CDT codes and that DHMO (Delta Care) dentists are paid on a capitated basis and have continued to receive standard payments. Delta also described a loan program to support contracted dentists.
Plan updates: Debbie McConathy of Kaiser Permanente said Kaiser will add a wheelchair gurney-van transportation benefit effective Sept. 1, 2020, and summarized grant-funded work to support contact tracing and investments in communities disproportionately affected by COVID.
What this means for members: Plan representatives emphasized calling your primary care or plan advice line when symptomatic, checking carrier guidance on testing locations and understanding that in-network dental visits generally should not carry an extra PPE surcharge; out-of-network providers may bill members. The SFHSS website and plan pages contain links and the presentation materials with further details.
Sources: Aon presentation; Executive Director Yant; Debbie McConathy (Kaiser); Sharon Staneklo (Delta Dental).
