As with many newer or more experimental medical procedures, telemedicine services can sometimes fall in the gray area for insurance carriers. Do your patients' insurance plans cover it? Will they reimburse you, as the physician, for the service? If so, what specific requirements do they have?
Telemedicine is still a relatively new kind of healthcare service. The good news is, most larger insurance carriers are catching on and offering broader coverage. For example, last year United Healthcare decided to expand their coverage for virtual visits.
So what about your patients? How do you find out whether their insurance will cover telemedicine?
Here are a few basic tips to guide you through the insurance verification process.
The big five carriers offer policy-dependent coverage.
The big five insurance carriers (BCBS, United Heathcare, Signa, Aetna, Humana) all offer some form of coverage for telehealth services. However, telehealth is often still listed as a policy-dependent medical service. That means, a patient with your practice who has a BCBS gold plan could have telemedicine as an included service under their plan, while a patient with a similar, cheaper BCBS bronze plan might not.
This means just knowing whether BCBS covers telehealth services for plans in your state isn't enough. Either your staff or the patient needs to call the insurance company and ask if telehealth is covered under their specific policy.
Verify whether telehealth is an included service for the insurance policy.
It's time to call the insurance company and ask a few questions. Depending on how you want to handle the workflow for telehealth services in your practice, you may want the patient to manage this themselves, or assign a staff member to call and verify coverage.
Either way, make sure to have this list of questions and a way to take notes when you call:
- Can you tell me the call reference number?
- Does the policy cover telehealth services?
- How do you define telehealth services? (What's included, does it have to be live video?)
- Is there a specific billing code that should be used?
- Are there any specific restrictions around the service, such as coverage is limited to 12 times a year?
- Does the service require any special documentation from the doctor?
The rep should be able to answer these questions for you and clarify any issues around coverage. It's crucial that you document all of this, along with the call reference number! The call reference number is essentially your golden ticket to prove your case, should any issues come up. Later on down the road, if a claim was denied and you can cite your reference number to say that it should be covered - the carrier has to do so.
Consider using a special telehealth verification form.
If you'd like to take documenting verification on step further to streamline the process, consider creating your own telehealth verification form. Or use our handy sample one here, and customize it to fit your practice.
Save all the information in one central location.
Once you go through the trouble of verifying that a patient's policy covers telehealth, you'll know that any other patients with the same plan should be covered as well! You may want to keep a running list of specific policies that you've verified in your EHR or in another central place in your office, where staff can easily access it.
Do cash-pay and skip the whole verification process.
There is another option for healthcare providers who aren't keen to to have staff or patients handle this process - offer telehealth on a cash-pay basis. Instead of billing through insurance for telehealth visits, simply charge patients directly. Just make sure you have patients sign a waiver saying they're ok not using insurance for that service, to cover all your bases.
Verifying coverage for telehealth can take a couple extra steps, but it's relatively straightforward once you understand these few tips. If all else fails, you can always do telehealth with a direct-pay model. It all depends on the right telehealth billing policy for your practice.