BCBS Network Waives Cost Sharing for Members’ Telehealth Coverage The national network of 36 independent health plans is expanding coverage for an estimated one in every three Americans, giving them no-cost access to telehealth services from in-network providers.

Blue Cross and Blue Shield of Texas (BCBSTX) today announced that it will temporarily lift cost-sharing for medically necessary medical and behavioral health services delivered via telemedicine. This applies to all fully insured members who receive covered in-network telemedicine services.

• Not have to worry about paying cost-sharing such as deductibles, coinsurance and copays through June 30, 2021. Self-funded employer groups for which Highmark administers benefits may, however, opt-out of this waiver. Highmark is also extending the waiver of cost-sharing for in-network telehealth visits through June 30.
• Effective April 1, 2020 through June 30, 2021, we are waiving all copays, coinsurance, and deductibles (including deductibles on HSA plans) for the treatment of an active COVID-19 infection delivered to any of your BlueCross BlueShield fully-insured Commercial and Medicare Advantage members.

“First and foremost, we want to make sure our members get the care they need,” said Dr. Dan McCoy, BCBSTX president. “Waiving copays for telemedicine will allow our members to consult a qualified health care provider while avoiding unnecessary visits to clinics, hospitals and emergency rooms.”

Benefits may be different for our members covered under certain employer-funded health plan’s depending on the decisions their employer makes about telemedicine.

Between now and April 30, BCBSTX will continue to consider whether to extend the timeframe of this temporary cost-sharing change.

There are two ways our eligible, fully insured members can access these telemedicine benefits at no cost share:

• Via BCBSTX in-network providers who offer the service through two-way, live interactive telephone and/or digital video consultations.
• Via their Virtual Visits benefit provided by BCBSTX and powered by MDLIVE, the doctor is in 24/7/365. Members can consult a board-certified doctor for non-emergency situations by phone, mobile app or online video. Virtual Visit doctors can send e-prescriptions to their local pharmacy.

Members can pick the easiest option to activate their MDLive account:

• Call MDLIVE at 1-888-680-8646
• Go to MDLIVE.com/BCBSTX
• Text BCBSTX to 635-483
• Download the MDLIVE app

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*Virtual Visits and telehealth services may not be available for all plans. Virtual Visits and telehealth services are subject to the terms and conditions of your benefit plan, including, but not limited to, benefits, limitations, and exclusions. Non-emergency medical service in Montana and New Mexico is limited to interactive online video. Non-emergency medical service in Arkansas and Idaho is limited to interactive online video for initial consultation. Other State law limitations may also apply.

Is Bcbs Still Waiving Telehealth Copays

MDLIVE is a separate company that operates and administers Virtual Visits for Blue Cross and Blue Shield of Texas. MDLIVE is solely responsible for its operations and for those of its contracted providers. MDLIVE operates subject to state laws and regulations and may not be available in certain states. MDLIVE is not an insurance product nor a prescription fulfillment warehouse. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA-controlled substances, non-therapeutic drugs and certain other drugs that may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services.

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About Blue Cross and Blue Shield of Texas
Blue Cross and Blue Shield of Texas (BCBSTX) — the only statewide, customer-owned health insurer in Texas — is the largest provider of health benefits in the state, working with nearly 80,000 physicians and health care practitioners, and 500 hospitals to serve more than 5 million members in all 254 counties. BCBSTX is a Division of Health Care Service Corporation (HCSC) (which operates Blue Cross and Blue Shield plans in Texas, Illinois, Montana, Oklahoma and New Mexico), the country’s largest customer-owned health insurer, and fourth largest health insurer overall. Health Care Service Corporation is a Mutual Legal Reserve Company and an Independent Licensee of the Blue Cross and Blue Shield Association.

CareFirst is encouraging members to call their doctor’s office if they have symptoms of the flu, COVID-19 or other contagious conditions. During this public health event, we understand the use of telemedicine is a practical option for members who wish to or should stay home. Therefore, we have temporarily expanded our telemedicine policy. Refer to our coding guidance for all existing and temporarily covered services.

Telemedicine Capability

If your practice has its own telemedicine capability (audio/video), proceed with visits and bill CareFirst as normal with a place of service “02” and refer to this guidance for accepted telemedicine procedure codes and modifiers. Services for diagnosis, consultation or treatment provided through telemedicine must meet all the requirements of a face-to-face consultation or contact between a licensed health care provider and a patient consistent with the provider's scope of practice for services appropriately provided through telemedicine services.

Federal Bcbs Copay

If the claim is to evaluate a member for coronavirus, use diagnosis code Z20.828 (Exposure to viral disease). If you are treating a member with confirmed coronavirus use diagnosis code B97.29 for dates of service prior to 4/1/20 and diagnosis code U07.1 for dates of service on and after 4/1/20. Utilization review may be performed. Documentation in the medical record must support the services rendered.

Is Blue Cross Blue Shield Waiving Copays

If you are currently not set up to conduct telemedicine, you can use a commercially available platform to conduct telemedicine visits. The Office for Civil Rights (OCR) at the HHS has stated that providers may use commercially available video chat services to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules during the COVID-19 nationwide public health emergency. Guidance and frequently asked questions can be found on their website.

Please note, CareFirst is waiving cost sharing for in-network or out-of-network visits to a provider’s office, including telemedicine, related to diagnosis and treatment of COVID-19. Providers are encouraged not to collect member cost sharing for these services. If a member does owe a copay or coinsurance after the claim is processed, you can bill the member as you do for all other claims. For these purposes we’ve defined telemedicine as a combination of interactive audio and video.

Bcbs Telehealth Codes

Member-Initiated Phone Consultations

CareFirst is paying for phone consultations provided by physicians and nurse practitioners credentialed in CareFirst’s network for the following specialties: primary care provider, internal medicine, OB/GYN, family practice and pediatrics. CareFirst will pay a $20 flat fee for CPT 99441.* We selected this code for all phone visits, regardless of the amount of time..

Bcbs Waiving Telehealth Copays California

* These benefits are covered for our fully insured members. We are also partnering closely with our self-insured customers to implement similar measures. Due to a change in D.C. law for members covered by a D.C. insured product, member-initiated phone calls are covered at $20, regardless of a provider’s specialty. Physicians and Nurse Practitioners should use CPT Codes 99441, 99442 or 99443. Non-physician providers should use CPT codes 98966, 98967 or 98968.