Unless ordered otherwise, most commercial payers will return to business as usual Jan. 1, or sooner.
The COVID-19 public health emergency (PHE) continues, but will expanded telehealth coverage and cost sharing waivers? Some health insurers will stop paying for expanded telehealth services as soon as Oct. 1. Patient cost-sharing may resume soon, as well.
In the 2021 Physician Fee Schedule Proposed Rule the Centers for Medicare & Medicaid Services (CMS) is proposing changes to expand certain telehealth flexibilities permanently. But other payers may adopt different policies with varying timelines. Take a look at where the top 10 health insurance companies stand on the matter right now.
Health Insurance Companies’ Stance on COVID-19 PHE Exceptions
Under Medicare Advantage, individual, and fully insured group market plans, UHC extended the cost share waiver for telehealth services for in- and out-of-network providers through Oct. 22 for COVID-19 related services. For non-COVID-19 related services, UHC is ending cost sharing wavier Sept. 30. Beginning Oct. 1, benefits will be adjudicated in accordance with the member’s benefit plan.
For in-network providers, UHC extended the expansion of telehealth access (including virtual check-ins and electronic visits) for all services, per the CMS interim final rule, through Dec. 31. But out-of-network providers have until the end of the PHE, currently Oct. 22. This applies to Medicare Advantage and individual and fully insured group market health plans. The expansion of telehealth access ended July 24 for out-of-network providers.
Refer to UHC’s telehealth guide for full details.
Kaiser Permanente is upholding the cost sharing waivers for member out-of-pocket costs related to COVID-19 to all of its fully insured benefit plans in all markets through Dec. 31.
From March 17 through Dec. 31, Anthem will waive member cost shares for telehealth visits from in-network providers, including visits for mental health and substance use disorders, for their affiliated health plans and Medicare Advantage and Medicaid plans, where permissible.
For out-of-network providers, cost sharing ended June 14.
Humana is waiving patient cost sharing for primary care office and telehealth visits, and also outpatient, non-facility based behavioral health visits, to Medicare Advantage members for the rest of 2020.
CVS Health (Aetna)
Aetna has extended through Dec. 31 all member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services for their Medicare Advantage, commercial, and student health plans. Self-insured plans offer this waiver at their own discretion. Medicare Advantage patients may use telemedicine for any reason, not just COVID-19-related services. This coverage policy does not apply to out-of-network providers.
Health Care Service Corporation
Out-of-pockets costs are waived for outpatient care and for emergency care at an emergency facility from April 1 through Oct. 23.
Centene is waiving all cost sharing for in-network primary care, behavioral health, and telehealth visits for the remainder of the calendar year for Medicare Advantage members.
Cigna is offering coverage through year-end, but cost shares ends Oct. 31 unless COVID-19 related. Effective Aug. 1, cost shares will be waived only when providers bill U07.1 COVID-19 Confirmed Cases, virus identified.
The payer has extended its interim virtual care and eConsult guidelines through “at least December 31, 2020.”
“Any services that can be delivered virtually will be eligible for telehealth coverage,” the company says on its website, with zero cost sharing to patients. All prior authorization requirements for telehealth services are lifted for dates of service from March 17 through Oct. 25.
Molina Healthcare Inc.
Molina says it will pay providers “for a variety of modalities in lieu of in-person visits to support evaluation, assessment, and treatment of members.” These modalities include telemedicine for HIPAA compliant, interactive, real-time audio and video telecommunications, which are already covered, and other forms of telehealth such as online digital exchange through a patient portal, telephone call, FaceTime, Skype or email. Molina is also waiving out-of-pocket costs associated with COVID-19 testing and treatment for its Medicare, Medicaid, and Marketplace members through Dec. 31.
Check Payer Policies
As you can see, insurers’ policies are all over the place. The only way you are going to code and bill correctly is to frequently check each company’s coverage policies for every plan they offer.
- Was the service COVID-19 related?
- Was the provider in-network?
- Was the service rendered in-office or remote?
- What is the date of service?
2020 has been a challenging year for coders and will continue as such. Expect more challenges in 2021 as we usher in new telehealth coverage, along side evaluation and management guideline and code changes.