Revisions to Payer Policies (Webinar #11)

Hey Folks,

Thanks to those of you that joined us last Thursday night for the PMI Covid19 Business Impact Webinar #11.
As a follow-up, I wanted to post here the updates that I mentioned last week. Yes, each plan is handling things differently and the dates for telemedicine and cost-sharing coverage are all over the place… and to reiterate - it is imperative that you make your voices heard to the AAP, to Payers, to Patients, to their Employers, that telemedicine should continue to be covered at the network level.

June 4th

  • member cost sharing waivers end. You now need to charge your patients a copay/coinsurance/deductible;
  • payment for phone call codes ends (99441-99443, 98966-98968)
    August 4th
  • telemed services covered only through Aug 4th, including well visits
  • note that well visits are covered via telemed AND any follow up in-office procedures and services (like vaccines) will also be paid

July 31

  • member cost waivers continue for Covid-related issues only after 7/31
  • you need to collect copay/coinsurance/deductible after 7/31
  • will continue to cover phone codes until 7/31

Sept 13

  • member cost waivers continue for all TM services through 9/13
  • cost-share waivers for Covid-related issues continues through 12/31

June 18 and July 24

  • cost share waivers for Covid-related issues continue through 7/24
  • non-Covid issues, cost sharing after 6/18
  • unknown how long TM will be covered

No set date

  • continuing to waive cost-sharing
  • all services covered under TM (sick and well, any dx)

Dec 31

  • cost-share for all TM visits waived through 12/31
  • no end date for covering TM for in-net providers

If that are specific Payers you would like us to post, please let me know.



Susanne - was there an update on this for Aetna? I’m being told by my billing office that aetna will not cover any well visits over telehealth. true? False? I