Copays For Telehealth

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This document contains frequently asked questions about telehealth visits. For broader information about telehealth, see the following documents:. Telehealth for medical providers. Telehealth for behavioral health providers. Telemedicine Services Medical Policy. You can access these documents in the telehealth sections of our coronavirus. FEP will waive copays for all telehealth services provided by Teladoc® during this time for all members. The most convenient way to get care is by requesting a visit on the Teladoc app or online. If you’re new to Teladoc’s services, you can set up your account ahead of time. Learn more here. Through June 30, 2021, all member cost-sharing (deductibles, coinsurance and copays) for 24/7 telemedicine visits provided by American Well (www.amwell.com), Doctor On Demand (www.doctorondemand.com) and Teladoc (www.teladoc.com) will be waived regardless of medical diagnosis, including behavioral health services for those feeling high levels of stress or anxiety.

© The Mighty Close-up Of A Man Using Laptop To Communicate With Doctor

By Jay Hancock, Kaiser Health News

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Karen Taylor had been coughing for weeks when she decided to see a doctor in early April. COVID-19 cases had just exceeded 5,000 in Texas, where she lives.

Cigna, her health insurer, said it would waive out-of-pocket costs for “telehealth” patients seeking coronavirus screening through video conferences. So Taylor, a sales manager, talked with her physician on an internet video call.

The doctor’s office charged her $70. She protested. But “they said, ‘No, it goes toward your deductible and you’ve got to pay the whole $70,’” she said.

Policymakers and insurers across the country say they are eliminating copayments, deductibles and other barriers to telemedicine for patients confined at home who need a doctor for any reason.

“We are encouraging people to use telemedicine,” New York Gov. Andrew Cuomo said last month after ordering insurers to eliminate copays, typically collected at the time of a doctor visit, for telehealth visits.

But in a fragmented health system — which encompasses dozens of insurers, 50 state regulators and thousands of independent doctor practices ― the shift to cost-free telemedicine for patients is going far less smoothly than the speeches and press releases suggest. In some cases, doctors are billing for telephone calls that used to be free.

Patients say doctors and insurers are charging them upfront for video appointments and phone calls, not just copays but sometimes the entire cost of the visit, even if it’s covered by insurance.

Despite what politicians have promised, insurers said they were not able to immediately eliminate telehealth copays for millions of members who carry their cards but receive coverage through self-insured employers. Executives at telehealth organizations say insurers have been slow to update their software and policies.

“A lot of the insurers who said that they’re not going to charge copayments for telemedicine ― they haven’t implemented that,” said George Favvas, CEO of Circle Medical, a San Francisco company that delivers family medicine and other primary care via livestream. “That’s starting to hit us right now.”

One problem is that insurers have waived copays and other telehealth cost sharing for in-network doctors only. Another is that Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare and other carriers promoting telehealth have little power to change telemedicine benefits for self-insured employers whose claims they process.

Such plans cover more than 100 million Americans — more than the number of beneficiaries covered by the Medicare program for seniors or by Medicaid for low-income families. All four insurance giants say improved telehealth benefits don’t necessarily apply to such coverage. Nor can governors or state insurance regulators force those plans, which are regulated federally, to upgrade telehealth coverage.

“Many employer plans are eliminating cost sharing” now that federal regulators have eased the rules for certain kinds of plans to improve telehealth benefits, said Brian Marcotte, CEO of the Business Group on Health, a coalition of very large, mostly self-insured employers.

For many doctors, business and billings have plunged because of the coronavirus shutdown. New rules notwithstanding, many practices may be eager to collect telehealth revenue immediately from patients rather than wait for insurance companies to pay, said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University.

“A lot of providers may not have agreements in place with the plans that they work with to deliver services via telemedicine,” she said. “So these providers are protecting themselves upfront by either asking for full payment or by getting the copayment.”

David DeKeyser, a marketing strategist in Brooklyn, New York, sought a physician’s advice via video after coming in contact with someone who attended an event where coronavirus was detected. The office charged the whole visit — $280, not just the copay ― to his debit card without notifying him.

“It happened to be payday for me,” he said. A week earlier and the charge could have caused a bank overdraft, he said. An email exchange got the bill reversed, he said.

Aetna copays for telehealth

With wider acceptance, telehealth calls have suddenly become an important and lucrative potential source of physician revenue. Medicare and some commercial insurers have said they will pay the same rate for video calls as for office visits.

Some doctors are charging for phone calls once considered an incidental and non-billable part of a previous office visit. Blue Cross plans in Massachusetts, Wyoming, Alabama and North Carolina are paying for phoned-in patient visits, according to America’s Health Insurance Plans, a lobbying group.

“A lot of carriers wouldn’t reimburse telephonic encounters” in the past, Corlette said.

Catherine Parisian, a professor in North Carolina, said what seemed like a routine follow-up call with her specialist last month became a telehealth consultation with an $80 copay.

“What would have been treated as a phone call, they now bill as telemedicine,” she said. “The physician would not call me without billing me.” She protested the charge and said she has not been billed yet.

By many accounts, the number of doctor encounters via video has soared since the Department of Health and Human Services said in mid-March that it would take “unprecedented steps to expand Americans’ access to telehealth services.”

Medicare expanded benefits to pay for most telemedicine nationwide instead of just for patients in rural areas and other limited circumstances, HHS said. The program has also temporarily dropped a ban on doctors waiving copays and other patient cost sharing. Such waivers might have been considered violations of federal anti-kickback laws.

At the same time, the CARES Act, passed by Congress last month to address the COVID-19 emergency, allows private, high-deductible health insurance to make an exception for telehealth in patient cost sharing. Such plans can now pay for video doctor visits even if patients haven’t met the deductible.

Dozens of private health insurers listed by AHIP say they have eliminated copays and other cost sharing for telemedicine. Cigna, however, has waived out-of-pocket costs only for telehealth associated with COVID-19 screening. Cigna did not respond to requests for comment.

Teladoc Health, a large, publicly traded telemedicine company, said its volume has doubled to 20,000 medical visits a day since early March. Its stock price has nearly doubled, too, since Jan. 1.

With such a sharp increase, it’s not surprising that insurers and physicians are struggling to keep up, said Circle Medical CEO Favvas.

“It’s going to be an imperfect process for a while,” he said. “It’s understandable given that things are moving so quickly.”

Abbie VanSickle, a California journalist, wanted her baby’s scheduled wellness visit done remotely because she worried about visiting a medical office during a pandemic. Her insurer, UnitedHealthcare, would not pay for it, the pediatrician told her. Mom and baby had to come in.

“It seems like such an unnecessary risk to take,” VanSickle said. “If we can’t do wellness visits, we’re surely not alone.”

A UnitedHealthcare spokesperson said that there was a misunderstanding and that the baby’s remote visit would be covered without a copay.

Jacklyn Grace Lacey, a New York City medical anthropologist, had a similar problem. She had to renew a prescription a few weeks after Cuomo ordered insurers to waive patient cost sharing for telehealth appointments.

The doctor’s office told her she needed to come in for a visit or book a telemedicine appointment. The video visit came with an “administrative fee” of $50 that she would have had to pay upfront, she said — five times what the copay would have been for an in-person session.

“I was not going to go into a doctor’s office and potentially expose people just to get a refill on my monthly medication,” she said.

Many insurance companies are currently waiving copays and deductibles for telehealth; while some are waiving these fees for all telehealth services, others are limited to COVID-19 related treatment only, and many require that the provider use the insurer’s preferred telemedicine platform.

Below is a list of health insurance companies, indicating which companies are waiving copays, coinsurances, and deductibles, and if so, when they will return to regular coverage. Most health insurance companies have not released updates since they first made changes in March, but we're keeping a close eye on the situation and will share updates as we have them!

For the latest information, we encourage you to visit the linked sources, which will take you to the health insurance company's relevant press release.

Please note that specifics vary across plans, especially employer-issued plans.

Cost-Sharing Waivers By Health Insurance During COVID-19

Aetna

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: For all Aetna plans offering Teladoc® coverage, cost sharing will be waived for all Teladoc® virtual visits. For all Commercial plans, cost sharing will also be waived for real-time virtual visits offered by in-network providers.
  • Applicable plans: Applies to all Aetna plans; self-insured plan sponsors can opt out.
  • Description: Until at least June 4th, 2020, Aetna will waive member cost sharing for any covered telemedicine visits — regardless of diagnosis. For all Aetna plans offering Teladoc® coverage, cost sharing will be waived for all Teladoc® virtual visits. Cost sharing will also be waived for real-time virtual visits offered by in-network providers (live video-conferencing and telephone-only telemedicine services) for all Commercial plan designs. Members may use telemedicine services for any reason, not just COVID-19 diagnosis. Self-insured plan sponsors will be able to opt-out of this program at their discretion.
  • Notes: If clients have self-insured plans, it is important to check that the plan has not opted out of the program.
  • Sources: Source one, Source two

Allways Health Partners

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists.
  • Applicable plans: Not explicitly indicated.
  • Description: AllWays Health Partners is removing cost-sharing (copayments, deductibles, or coinsurance) for testing and copayments for treatment at in-network facilities; ensuring access to out-of-network providers for the initial COVID-19 test or treatment when no in-network providers are available; and removing all cost-sharing for telemedicine services, including virtual visits with primary care providers and specialists, and through Partners HealthCare On Demand, to enable members to seek COVID-19-related care without the need to go to medical offices... There will be no cost to you for telemedicine (including telephone) visits for standard/routine outpatient behavioral health.
  • Sources:Source

Anthem

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists
  • Applicable plans: Applies to all Anthem affiliated plans; self-insured plan sponsors can opt out.
  • Description: For 90 days effective March 17, 2020, Anthem’s affiliated health plans will waive member cost shares for telehealth visits, including visits for mental health or substance use disorders, for our fully-insured employer plans, individual plans, Medicare plans and Medicaid plans, where permissible. Cost sharing will be waived for members using Anthem’s authorized telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. Self-insured plan sponsors may opt out of this program.
  • Sources:Source

Blue Cross Blue Shield Association

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists
  • Applicable plans: All 'fully-insured' members
  • Description: 'All 36 independently-operated BCBS companies and the Blue Cross and Blue Shield Federal Employee Program® (FEP®) are expanding coverage for telehealth services for the next 90 days. The expanded coverage includes waiving cost-sharing for telehealth services for fully-insured members and applies to in network telehealth providers who are providing appropriate medical services. We are also advocating for physician and health system adoption of social distancing-encouraged capabilities such as video, chat and/or e-visits. This builds on the commitment we previously announced to ensure swift and smooth access to care during the COVID-19 outbreak.'
  • Sources:Source

Blue Cross Blue Shield of Massachusetts

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists
  • Applicable plans: All members
  • Description: 'Blue Cross has waived member cost share (co-pays, co-insurance and deductibles) for all medically necessary medical and behavioral health covered services, via phone or video (telehealth) with in-network providers if such services are offered.'
  • Sources: Source

Blue Cross and Blue Shield of Illinois

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists
  • Applicable plans: All BCBSIL members with telemedicine/telehealth benefits in their plan (excluding Part D plans for Medicare members)
  • Description: 'Currently, if you are insured by BCBSIL, including Medicare (excluding Part D plans) and Medicare Supplement members, you can: Access provider visits for covered services through telemedicine or telehealth as outlined in your benefit plan. You won’t pay copays, deductibles, or coinsurance on in-network covered telemedicine or telehealth services.'
  • Sources: Source

Blue Cross and Blue Shield of Rhode Island

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists
  • Applicable plans: All members
  • Description: Expanded coverage for clinically appropriate telehealth services that are provided by any in-network provider through permitted means, including telephone and audiovisual technologies. Permitted audiovisual capabilities include nonpublic video conferencing such as Skype, Google Hangouts and FaceTime. Waived all member cost sharing (copays and deductibles) for telehealth whether provided by an in-network provider or through the Doctors Online telehealth platform.
  • Sources: Source

Blue Shield of California

  • Cost sharing waived for teletherapy? Yes, but only for Teladoc Services
  • Applicable providers: Only waiving costs for Teladoc Health virtual care service.
  • Applicable plans: Applies to Blue Shield’s Individual and Family Plans, Medicare Supplemental plans, Medicare Advantage plans, as well as employer- and union insured plans.
  • Description: 'Blue Shield previously announced it is waiving prior approval and copayments for Teladoc Health virtual care service through May 31, 2020 for most of its members. Not all plans have access to these services.'
  • Sources:Source

Cigna

  • Cost sharing waived for teletherapy? No (only for categories of 'screening, diagnosis, or testing' for COVID-19)
  • Applicable providers: N/A
  • Applicable plans: N/A
  • Description: 'Effective today, Cigna is waiving customer cost-sharing for all COVID-19 treatment through May 31, 2020. The treatments that Cigna will cover for COVID-19 are those covered under Medicare or other applicable state regulations. The company will reimburse health care providers at Cigna's in-network rates or Medicare rates, as applicable. Will Cigna cover Coronavirus virtual care visits? Yes. If your visit is related to screening, diagnosis, or testing for the Coronavirus, your out-of-pocket costs will be waived.'
  • Sources: Source

ConnectiCare

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network
  • Applicable plans: All members
  • Description: 'Today, ConnectiCare, one of the region’s leading health plans, announced that members can temporarily use telehealth for covered medical and mental health services at no cost. To make it easier for our members to get the care they need, ConnectiCare is eliminating the financial burden associated with office visits by covering telehealth appointments for any reason.' The company is allowing no-cost member real time visits with medical and mental health professionals by phone, computer, and mobile app.'
  • Sources:Source

EmblemHealth

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network
  • Applicable plans: All except potentially not ASO plans
  • Description: 'EmblemHealth members across all our product lines will have no cost sharing (including copayments, coinsurance, or deductibles) for in-network telehealth visits. These visits have no cost-sharing for COVID-19 and non-COVID-19 related services. Members with a benefit plan that includes the Teladoc™ program will also have no cost-sharing for Teladoc visits. The telehealth cost-sharing waiver may not apply to ASO plans.'
  • Sources:Source

First Choice Health

  • Cost sharing waived for teletherapy? No (only for virtual primary care service, not teletherapy)
  • Applicable providers: N/A
  • Applicable plans: N/A
  • Description: 'To help ensure people will have access to a doctor during the current COVID-19 crisis, First Choice Health (FCH), a leading provider-owned healthcare administrator in the Northwest, has announced that it is covering the cost of telehealth services for its self-funded employer customers via on-demand primary care service 98point6.'
  • Sources:Source

Harvard Pilgrim Health Care

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network
  • Applicable plans: Members on individual and group fully insured plans
  • Description: All telemedicine services: Covered in full (no copays, deductibles or coinsurance)
  • Sources: Source

Healthfirst

  • Cost sharing waived for teletherapy? No (only COVID-19 related testing and evaluation)
  • Applicable providers: N/A
  • Applicable plans: N/A
  • Description: 'Healthfirst is waiving co-pays for all diagnostic testing and evaluations related to coronavirus.'
  • Sources: Source

Copays For Telehealth

HealthPartners

  • Cost sharing waived for teletherapy? No (only COVID-19 related testing and diagnosis)
  • Applicable providers: N/A
  • Applicable plans: N/A
  • Description: 'If you’re a HealthPartners member, you have coverage with no member cost sharing for COVID-19 testing and diagnosis. This includes the cost of the care visit associated with testing.'
  • Sources: Source

Kaiser Permanente

  • Cost sharing waived for teletherapy? No (only COVID-19 related screening and testing fully covered)
  • Applicable providers: N/A
  • Applicable plans: N/A
  • Description: 'We’re proactively extending the use of telehealth appointments via video and phone where appropriate. As a Kaiser Permanente member, you won’t have to pay for costs related to COVID-19 screening or testing if referred by a Kaiser Permanente doctor. If you’re diagnosed with COVID-19, additional services, including hospital admission (if applicable), will be covered according to your plan details.'
  • Sources: Source

Magellan Health

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists
  • Applicable plans: All members
  • Description: 'As the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) guidance came out on Tuesday, Magellan was revising its operations to permit all credentialed and contracted behavioral health providers to conduct telehealth video sessions for all routine services and certain psychological testing, applied behavior analysis (ABA), intensive outpatient programs (IOP) and partial hospitalization program (PHP) services. Providers are able to use a number of HHS OCR-approved platforms to conduct their telehealth video sessions. Magellan is also allowing telephone-only sessions when a member has no access to a video platform. These alternative approaches will be covered to ensure members get the care they need, when they need it. Our experienced behavioral health network providers are available to serve the needs of our clients’ members through a variety of avenues. We are proud of our network providers and look forward to working with them to support those who may need mental health services as a result of the COVID-19 outbreak.'
  • Sources: Source
Copays For Telehealth

Neighborhood Health Plan of Rhode Island

  • Cost sharing waived for teletherapy? Yes, but only for Optum-based virtual visits
  • Applicable providers: Optum virtual visits only for behavioral health
  • Applicable plans: All members
  • Description: 'Neighborhood’s behavioral health partner Optum, offers virtual visits so you can receive confidential care without leaving your home. For more information on accessing virtual visits, go to live and work well to locate providers and schedule an appointment with them online. Neighborhood has expanded telemedicine coverage for all members to include clinically appropriate and medically necessary services to support you not having to go into your doctor’s office, urgent cares or emergency rooms during the time of the Governor’s executive order. If your plan usually has co pays, deductibles or other cost-sharing, you will not need to pay for the services outlined below. Primary care physicians All Medical Specialists – defined as any MD, DO, NP and PA Optometrists Doctors of Podiatric Medicine (DPM’s) Lactation Consultants Physical, Occupational, and Speech Therapists Diabetes Educators Nutritionists Midwifes Urgent Care Centers Emergency Departments Retail Based Clinics'
  • Sources: Source

Oscar

  • Cost sharing waived for teletherapy? No; standard cost sharing rules apply for teletherapy
  • Applicable providers: Offering Oscar's Doctor on Call for 'most members' free of charge
  • Applicable plans: Varies depending on details of individual plans
  • Description: 'In addition to offering Oscar's Doctor on Call services to most members for $0, Oscar will cover all COVID-19 care delivered via telemedicine at $0 for our members through May 10. We will re-evaluate this date as needed. Oscar will also cover telemedicine care, consistent with our plan terms, for our members when they see an in-network provider through May 10. Standard cost-sharing rules will apply in all states except New York and New Jersey. In these states, members will pay $0 for any medically-necessary telemedicine visit with an in-network provider.'
  • Sources: Source
Aetna waive copay for telehealth

Premera Blue Cross

  • Cost sharing waived for teletherapy? No; only through certain platforms
  • Applicable providers: Specific services only (Talkspace for therapy)
  • Applicable plans: Varies depending on 'participating groups'
  • Description: 'To ease the burden for our members, we will waive copays, deductibles, and coinsurance for COVID-19 related treatment (both inpatient and outpatient). This waiver will continue through October 1, 2020 for participating groups. We've expanded options for you: Call your in-network primary care doctor's office. 24-Hour NurseLine is available at no charge. Just call the number on the back of your member ID card to reach medical professionals. Doctor On Demand is a video chat with a doctor. 98point6 is a text-based primary care app. Talkspace offers virtual access to licensed therapists.'
  • Sources: Source

UnitedHealthcare

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists
  • Applicable plans: Medicare Advantage, Medicaid, Individual and Group Market fully insured health plans
  • Description: 'Starting March 31, 2020 until June 18, 2020, UnitedHealthcare will now also waive cost-sharing for in-network, non-COVID-19 telehealth visits for its Medicare Advantage, Medicaid, Individual and Group Market fully insured health plans. Again, we will work with self-funded customers who want us to implement a similar approach. The company previously announced we would waive cost-sharing for telehealth visits related to COVID-19 testing, in addition to waiving cost-sharing for 24/7 Virtual Visits with preferred telehealth partners.'
  • Sources: Source

Is Blue Shield Waiving Copays For Telehealth

Medicare coverage

Cigna Copays For Telehealth

For the duration of the Public Health Emergency (PHE) declared by the Secretary of Health and Human Services, CMS will be making these changes. The main note is that there will no longer be a limit on the originating site -- the place where a client or patient is receiving care. Clients can now temporarily receive telehealth visits in their home, regardless of whether they are located in a rural area.

Waived Cost End Dates

Insurance companies are planning to waive fees until the dates listed below. They will be re-evaluating and updating these dates as the situation progresses.

  • Aetna: June 4, 2020 (source)
  • Anthem: June 15, 2020 (source)
  • Cigna: May 31, 2020 (source)
  • Blue Cross Blue Shield: June 15, 2020 (source) ('All 36 independently-operated BCBS companies and the Blue Cross and Blue Shield Federal Employee Program® (FEP®) are expanding coverage for telehealth services for the next 90 days. The expanded coverage includes waiving cost-sharing for telehealth services for fully-insured members and applies to in network telehealth providers who are providing appropriate medical services.' 90 days from the publication date of this press release of March 19th, 2020, takes us to about June 15th, 2020 (calculation), which is how we arrived at this end date.)
  • Empire Blue Cross Blue Shield: June 15, 2020 (or “as long as the COVID-19 emergency is in effect.”) (source)
  • UnitedHealthcare: June 18, 2020 (source)

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