Private Payers & Telemedicine

 

Private payers like United Healthcare and Blue Cross Blue Shield are starting to jump on the telemedicine bandwagon. With incredible cost-savings, better patient outcomes, and huge convenience for the patient, telemedicine just makes sense.

Here’s what you should know about private payers and telemedicine reimbursement!

Parity Laws

What’s a telemedicine parity law? If you’ve been researching telemedicine, you’ve probably seen this phrase around. Parity means equal.

When a state passes a telemedicine parity law, it means private payers in that state have to reimburse for telemedicine care in the same way they would for in-person care. So whenever a new parity law passes, it’s a huge win for telemedicine!

If your state doesn’t have a telemedicine parity law right now, don’t sweat! Many private payers still cover telemedicine anyway. They’re just not legally required to reimburse.29 states and counting.

29 states and Washington D.C. have now passed telemedicine parity laws. And this number will keep going up! 8 additional states currently have proposed parity laws on the table. Plus, commercial payers are increasing motivated to cover telemedicine anyway, because of the cost-savings it can bring.

Here’s the list of states that currently have a parity law in place:

AZ,  AR,  CA,  CO,  CT,  DE,  Washington DC,  GA,  HI,  IN,  KT,  LA,  ME,  MD,  MI,  MN,  MS,  MO,  MT,  NV,  NH,  NM, NY,  OK,  OR,  TN,  TX,  VT,  VA,  WA

All parity laws mandate coverage for live video telemedicine, but only some also require payers to cover store-and-forward telemedicine. Some of the parity laws also have specific restrictions and exclusions. Make sure to visit the ATA website to review the parity law in your state.These states have proposed parity laws and are waiting for further action:

IL, IA, MA, NJ, NC, OH, PA, RI

Want to stay up-to-date on the status of state telemedicine parity laws? Bookmark this handy state legislation matrix from the American Telemedicine Association (ATA).

The major commercial payers all cover telemedicine

Our staff has called around to the Big Five – Aetna, Cigna, Blue Cross Blue Shield, Humana, and United Healthcare – and found that all offer some form of coverage for telemedicine. That’s huge!

However, what and when these private payers will cover telemedicine depends on a few different factors.

Telemedicine coverage is policy-dependent

What does this mean? While Blue Cross Blue Shield might say they cover telemedicine, they may only reimburse for telemedicine services on certain patient policies. For instance, a patient with a more expensive BCBS gold policy might have coverage for telemedicine, while a patient with a cheaper BCBS bronze policy may have telemedicine care listed as an excluded service.

The best way to verify coverage? Call your payers and ask the right questions.

Reimbursement Rates

How much providers are paid for telemedicine services depends on the policy in that state, and of course, your negotiated reimbursement rates with that payer.

In most cases, private payers seem to reimburse at the same rate as the comparable in-person service.

How to bill Private Payers

Guidelines for billing telemedicine vary depending on the payer. It’s easiest just to call up the eligibility and benefits departments of your commercial payers and ask them what codes and documentation you’ll need to use when billing telemedicine.

Our staff has generally found that private payers are following the lead of Medicare – advising providers to use the appropriate CPT/HCPCS code along with the GT modifier. However, you should always call and verify with your payers.

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