Many insurers have stated that they will be waiving cost sharing for their insureds, either for COVID-19 related care, all care, telehealth visits or some other category of care. However, it is unclear whether they mean that they (the insurer) will make those payments to providers instead of the patient being responsible, or whether they will expect providers to eat those amounts (thereby reducing our total payment.
This reads to me that they only are waiving cost-sharing specifically for COVID-19 visits.
" Ensuring full provider reimbursements for waived member cost-sharing for COVID-19 testing and treatment. Aetna will pay the amount of the cost-sharing the member would have ordinarily paid related to COVID-19 testing or inpatient treatment so there is no financial impact on the provider."
That doesn’t apply to most of our telehealth visits. Any clarity or additional info anyone?
Most cost sharing in our area is directed to COVID19 related illness or testing and does not apply to other visits. So we are billing and charging as usual for visits and discussing with families that if their insurance does cost sharing then the family will be reimbursed. Would be incredibly difficult to figure out who cost shares and for what at the front desk. For ones that Cost share for COVID19, the front desk wouldn’t know what diagnosis we will ultimately use anyway. Would recommend keep collecting at check in as you normally do and explain to families that ask about cost sharing that they will be reimbursed if this is the case. Also agree the total payment is the same either way and we are not eating copays. This would be against our contracts.
It does–but the point above says that they will pay for telehealth at the same rate as in office services. So I interpret it to mean that EITHER they will not waive cost sharing for telehealth and we still collect as usual from patient, or they will for COVID-related services, and pay us the full amount. And a lot of our telehealth visits are COVID related, at least in part, and we are using the appropriate codes to indicate that. I haven’t seen payment EOBs yet to judge the effectiveness oof what we are doing
Like most insurance statements, clarity is intentionally absent.
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