Telehealth: Am I covered?

female doctor providing virtual patient care via telehealthTelehealth, or virtual healthcare, is a necessity that we’ve come to depend on in the era of COVID-19. People are generally less willing to leave their homes for doctors’ appointments, and those at high risk will not put themselves in dicey situations they can avoid. And those fears aren’t just anecdotal; some telehealth providers reported over 250% growth in visits in the first month of the pandemic.

With many children taking online classes from home, parents are unable to leave them alone in the middle of the day, nor are they able to take them to the doctor’s office. Meanwhile, providers may fear the liability of having a crowded waiting room, making it more difficult than ever to get an appointment with your physician of choice. The pandemic has introduced several problems regarding receiving essential primary care.

Luckily, they all share a solution — telehealth. Many doctors’ appointments are simple checkups that can be done over the phone or through a video call from the safety of your home. Sometimes these visits are as simple as verbally going over symptoms (or the lack thereof) to get a prescription refill. 

Telehealth will be the new normal even after life begins to look more like it did pre-2020. It’s a new normal that presents benefits to all parties involved and one that shouldn’t be viewed as just another new revenue stream for insurance companies. At Sana Benefits, we aren’t making it one, focusing instead on increasing telehealth adoption as part of our mission to be the leader in value-based healthcare solutions. Below we’ll expand on what we are doing for our members and look at what other carriers are doing for those who want to use telehealth services. 

Sana Benefits: Sana members get full access to PlushCare, which provides personalized, 24/7 virtual primary care and mental health visits for a $0 copay. You can speak to the next available doctor or book an appointment to have a video chat with a physician, fill a prescription, and more at no cost. All Sana Benefits members are eligible for this benefit, regardless of your plan.

This is what it will look like when you enter your Sana member number in the Plushcare app or on PlushCare.com:

BlueCross BlueShield: As a BCBS member, your coverage may or may not include access to telehealth provider MDLIVE. Telehealth services are not 100% covered under BCBS Texas small group health plans. You will be required to log in to your account and look into your coverage to ensure you have the Virtual Visit benefit, and the associated out-of-pocket costs will be for care.

Humana: Humana members also get access to virtual visits through MDLIVE with some of their plans as well. However, you’ll need to log in to find out if your plan qualifies and what your possible out-of-pocket costs will be. Humana has temporarily waived out-of-pocket expenses from telehealth visits due to COVID-19 for the rest of 2020, but these costs will likely be back sometime in 2021.

Aetna: If you are an Aetna member, you can access Teladoc, another popular virtual healthcare provider. Using Teladoc or Aetna’s other partner, MinuteClinic E-Clinic, will cost patients the same copay as you would pay for an in-person provider visit. On the positive side, Aetna is offering $0 copays for mental health visits, but the insurer does state that you should verify your specific plan has this coverage.

United Healthcare: United members have access to several options, including Teladoc, Doctor on Demand and American Well. Most United plans have coverage, but it’s best to check to make sure your plan is included. Mental health visits may or may not be covered as well. The average cost for a telehealth visit is $50.

Cigna: Members of Cigna also have telehealth options like MDLIVE and American Well, but there will likely be costs associated with your virtual visits. Cigna’s Telehealth Connection site notes that ‘your out-of-pocket cost is the same or less than a visit with your primary care provider.’ For example, the member share of costs for an MDLIVE visit can be up to $55.

Oscar: A newer provider of health insurance to individuals and families, Oscar will be launching its telehealth services in January 2021. It will be included in some Oscar individual/family plans and will include $0 copays for virtual visits.

Many primary care physicians are pivoting to offer both virtual and in-person visits, so remind employees to check with their doctors to see what their options are if they don’t want to make the trip to the office. Telehealth will continue to be an integral part of health plans, so ensure you’re getting the options and coverage your employees need when comparing your health insurance options. 

Originally published Oct 27, 2020 01:08:33 PM
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Evan Knopp October 27, 2020

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