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• Is There A Copay For Telehealth

Jeffrey Davis
UPMC Health Plan
412-454-9684
davisjr5@upmc.edu

Pittsburgh (April 6, 2020) – UPMC Health Plan announced today that it is waiving all deductibles, co-insurance and co-pays for all in-network, inpatient COVID-19 treatment for its members enrolled in fully-insured group, ACA and Medicare Advantage plans, as well as in self-insured employer group plans that opt in to this coverage. This policy change is effective immediately and will stay in effect through June 15, 2020.

Manage appointments, communicate with your doctor, pay bills, renew prescriptions, and view your medical records and lab results with MyUPMC. Pittsburgh (March 13, 2020) – UPMC Health Plan is committed to continuing to provide our members with world-class information, assessment, and treatment related to coronavirus (COVID-19). 'As part of one of the largest integrated health systems in the nation, we at UPMC Health Plan will do everything we can to address this global pandemic,' said Joon Lee, MD, chief medical officer for UPMC. Telehealth services like UPMC AnywhereCare are a convenient and easy way to get a medical evaluation from home or the office if you're experiencing common conditions like cold, sore throat, or think you are experiencing coronavirus symptoms. You can get medical attention quickly and safely at $0 copay when you use UPMC AnywhereCare. UPMC CCP - GIL, Pittsburgh6343 Penn Avenue, Suite 201, Pittsburgh, PA 15206 (Map) 412-363-2200 UPMC CCP - GIL, Murrysville 1000 Infinity Drive, Suite 100, Monroeville, PA 15146 ( Map ). 200 Lothrop Street Pittsburgh, PA 15213 412-647-8762 800-533-8762.

“Our members have enough to think about during this challenging time and worrying about whether they can afford COVID-19 treatment should not be one of them,” said Diane Holder, President and CEO of UPMC Health Plan. “At a time of uncertainty, one thing UPMC Health Plan members can count on is that they will not have to pay out of pocket for COVID-19 treatment.”

Covering out-of-pocket costs for COVID-19 testing and now treatment are just two of the ways UPMC Health Plan is reaching out to support its employers and members during the COVID-19 pandemic. In addition, UPMC Health Plan is:

Providing additional flexibility to businesses—

UPMC Health Plan is working to assist its employer groups by offering additional flexibility and will host a WebEx with the U.S. Small Business Administration and Huntington Bank on April 7 to talk about certain options.

Waiving cost-sharing for telehealth—

UPMC Health Plan removed deductibles, copayments and cost-sharing for all in-network virtual visits with a health care provider, including telehealth services through UPMC AnywhereCare, until June 15. UPMC AnywhereCare is available 7 days a week, 24 hours a day.

Allowing early prescription refills—

UPMC Health Plan increased member access to medications by waiving early refill limits until June 15 on prescriptions filled at retail, mail and specialty pharmacies.

UPMC MyHealth 24/7 Nurse Line—

UPMC Health Plan offers members the MyHealth 24/7 Nurse Line. This resource allows UPMC Health Plan members to speak directly with a UPMC nurse 24 hours a day, 7 days a week, when non-emergency care is needed. Our nurses can offer immediate support and advice regarding specific services members may need to assist with their care needs. UPMC Health Plan members can access the MyHealth 24/7 Nurse Line by calling 1-866-918-1591.

UPMC LifeSolutions—

UPMC Health Plan expanded access to UPMC LifeSolutions, a telephonic service dedicated to helping individuals cope with challenging situations. Specially trained counselors are poised and ready to help our members through this difficult and stressful life event.

Reliable education—

UPMC Health Plan updates its website with timely, trustworthy information on COVID-19, including useful resources and articles from UPMC doctors and links to other trusted sources, such as the Centers for Disease Control and Prevention.

For more information about the services UPMC Health Plan provides, you may go to www.upmchealthplan.com. For additional information on the coronavirus, you may go to www.upmc.com.

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About UPMC Insurance Services

UPMC Insurance Services is owned and operated by UPMC, a world-renowned health care provider and insurer based in Pittsburgh, Pa. UPMC Insurance Services—which includes UPMC Health Plan, Workpartners, UPMC for Life, UPMC for You, UPMC for Kids, and Community Care Behavioral Health—offers a full range of health insurance and benefit management services including Medicare, Special Needs, Children's Health Insurance, Medical Assistance, Behavioral Health, Employee Assistance, and Workers' Compensation products and services to over 3.7 million members. For more information, visit www.upmchealthplan.com.

By Jay Hancock, Kaiser Health News

Karen Taylor had been coughing for weeks when she decided to see a doctor in early April. COVID-19 cases had just exceeded 5,000 in Texas, where she lives.

Cigna, her health insurer, said it would waive out-of-pocket costs for “telehealth” patients seeking coronavirus screening through video conferences. So Taylor, a sales manager, talked with her physician on an internet video call.

The doctor’s office charged her $70. She protested. But “they said, ‘No, it goes toward your deductible and you’ve got to pay the whole $70,’” she said.

Policymakers and insurers across the country say they are eliminating copayments, deductibles and other barriers to telemedicine for patients confined at home who need a doctor for any reason.

“We are encouraging people to use telemedicine,” New York Gov. Andrew Cuomo said last month after ordering insurers to eliminate copays, typically collected at the time of a doctor visit, for telehealth visits.

But in a fragmented health system — which encompasses dozens of insurers, 50 state regulators and thousands of independent doctor practices ― the shift to cost-free telemedicine for patients is going far less smoothly than the speeches and press releases suggest. In some cases, doctors are billing for telephone calls that used to be free.

Patients say doctors and insurers are charging them upfront for video appointments and phone calls, not just copays but sometimes the entire cost of the visit, even if it’s covered by insurance.

Despite what politicians have promised, insurers said they were not able to immediately eliminate telehealth copays for millions of members who carry their cards but receive coverage through self-insured employers. Executives at telehealth organizations say insurers have been slow to update their software and policies.

“A lot of the insurers who said that they’re not going to charge copayments for telemedicine ― they haven’t implemented that,” said George Favvas, CEO of Circle Medical, a San Francisco company that delivers family medicine and other primary care via livestream. “That’s starting to hit us right now.”

One problem is that insurers have waived copays and other telehealth cost sharing for in-network doctors only. Another is that Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare and other carriers promoting telehealth have little power to change telemedicine benefits for self-insured employers whose claims they process.

Such plans cover more than 100 million Americans — more than the number of beneficiaries covered by the Medicare program for seniors or by Medicaid for low-income families. All four insurance giants say improved telehealth benefits don’t necessarily apply to such coverage. Nor can governors or state insurance regulators force those plans, which are regulated federally, to upgrade telehealth coverage.

“Many employer plans are eliminating cost sharing” now that federal regulators have eased the rules for certain kinds of plans to improve telehealth benefits, said Brian Marcotte, CEO of the Business Group on Health, a coalition of very large, mostly self-insured employers.

For many doctors, business and billings have plunged because of the coronavirus shutdown. New rules notwithstanding, many practices may be eager to collect telehealth revenue immediately from patients rather than wait for insurance companies to pay, said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University.

“A lot of providers may not have agreements in place with the plans that they work with to deliver services via telemedicine,” she said. “So these providers are protecting themselves upfront by either asking for full payment or by getting the copayment.”

David DeKeyser, a marketing strategist in Brooklyn, New York, sought a physician’s advice via video after coming in contact with someone who attended an event where coronavirus was detected. The office charged the whole visit — $280, not just the copay ― to his debit card without notifying him.

“It happened to be payday for me,” he said. A week earlier and the charge could have caused a bank overdraft, he said. An email exchange got the bill reversed, he said.

With wider acceptance, telehealth calls have suddenly become an important and lucrative potential source of physician revenue. Medicare and some commercial insurers have said they will pay the same rate for video calls as for office visits.

Some doctors are charging for phone calls once considered an incidental and non-billable part of a previous office visit. Blue Cross plans in Massachusetts, Wyoming, Alabama and North Carolina are paying for phoned-in patient visits, according to America’s Health Insurance Plans, a lobbying group.

“A lot of carriers wouldn’t reimburse telephonic encounters” in the past, Corlette said.

Catherine Parisian, a professor in North Carolina, said what seemed like a routine follow-up call with her specialist last month became a telehealth consultation with an $80 copay.

“What would have been treated as a phone call, they now bill as telemedicine,” she said. “The physician would not call me without billing me.” She protested the charge and said she has not been billed yet.

By many accounts, the number of doctor encounters via video has soared since the Department of Health and Human Services said in mid-March that it would take “unprecedented steps to expand Americans’ access to telehealth services.”

Medicare expanded benefits to pay for most telemedicine nationwide instead of just for patients in rural areas and other limited circumstances, HHS said. The program has also temporarily dropped a ban on doctors waiving copays and other patient cost sharing. Such waivers might have been considered violations of federal anti-kickback laws.

At the same time, the CARES Act, passed by Congress last month to address the COVID-19 emergency, allows private, high-deductible health insurance to make an exception for telehealth in patient cost sharing. Such plans can now pay for video doctor visits even if patients haven’t met the deductible.

Dozens of private health insurers listed by AHIP say they have eliminated copays and other cost sharing for telemedicine. Cigna, however, has waived out-of-pocket costs only for telehealth associated with COVID-19 screening. Cigna did not respond to requests for comment.

Teladoc Health, a large, publicly traded telemedicine company, said its volume has doubled to 20,000 medical visits a day since early March. Its stock price has nearly doubled, too, since Jan. 1.

With such a sharp increase, it’s not surprising that insurers and physicians are struggling to keep up, said Circle Medical CEO Favvas.

Upmc Telemedicine

“It’s going to be an imperfect process for a while,” he said. “It’s understandable given that things are moving so quickly.”

Abbie VanSickle, a California journalist, wanted her baby’s scheduled wellness visit done remotely because she worried about visiting a medical office during a pandemic. Her insurer, UnitedHealthcare, would not pay for it, the pediatrician told her. Mom and baby had to come in.

“It seems like such an unnecessary risk to take,” VanSickle said. “If we can’t do wellness visits, we’re surely not alone.”

A UnitedHealthcare spokesperson said that there was a misunderstanding and that the baby’s remote visit would be covered without a copay.

Jacklyn Grace Lacey, a New York City medical anthropologist, had a similar problem. She had to renew a prescription a few weeks after Cuomo ordered insurers to waive patient cost sharing for telehealth appointments.

Upmc Waiving Copays

The doctor’s office told her she needed to come in for a visit or book a telemedicine appointment. The video visit came with an “administrative fee” of $50 that she would have had to pay upfront, she said — five times what the copay would have been for an in-person session.

Is There A Copay For Telehealth

“I was not going to go into a doctor’s office and potentially expose people just to get a refill on my monthly medication,” she said.