Televisit copays and cost for high deductible plans

The Urgent Care centers around us are offering televisits with no copay or cost to consumers. We have been charging normal copays up to this point and collecting $100 if patient has a high deductible plan (this is what we collect up front for a normal face to face visit when all costs will fall to deductible).

How do we complete without losing even more money? It is my understanding that televisits will be paid as a regular visit (we are in Texas where there is parity). If we don’t collect copays, this would drop our per visit revenue. If we don’t charge the high deductible plan folks, I doubt we would ever get that money.

Anyone with any advice?

We have same issue large hospitals near us offer 24/7 tele urgent care for $49/ visit and $15/ visit, price savvy consumers with HdHP will prob figure it cheaper to go that route

I don’t know if you watched the seminar on Thursday night, but this is why I brought up the issue of your local hospitals being friends or foes. The concept of PCMH has no meaning to some of them.

Chip can you comment… if they take insurance on these patients or have contracts. they can bill this fee? will the carriers not be upset and/or or adjust all visits to this price?

Every scene is local, but what we’re seeing retail and hospital-based clinics do is offer cut-rate access to “telemedicine” (air quotes mine) often in conjunction with big payers or simply at cash prices.

It’s a land grab and the folks at the front of the line are always payers and hospitals.

I thought tele-medicine had to be with established patients?

Real time audio/video visits may be done for new sick patients according to CPT. Many rules are suspended right now, too, depending on where you practice and which carrier covers the patient.

Although the reality of payment is on a payer-by-payer basis, the 9920X series is approved for payment by Medicare which, as we know, is where it all starts.

Dang it, you beat me by 10 seconds, @Jan!

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We are in a small practice call group with patients from other practices and we are converting all of our patient after hours call to tele health, it has worked out great, but you are saying we can do that for the other practices patients? Hmmm we would need to get their insurance cards i guess on the call and let them know we are billing them? I think that would be a tough one.

In my area, insurance companies like UHC and CIGNA, are offering our patients FREE telehealth visits. They are not charging copays or deductibles. Patients are telling us they would rather use the free service instead. I think this is very unfair of the insurance companies to be under-cutting us at a time when this is most possibly our only source of income. They are breaking our contracts with them and they don’t care.

You should be writing to the directors of the insurance companies (sample letter is posted here in the forum), to your elected officials, and to your local pediatric council!

Will work on that. We have already approached the insurance company directors long before the pandemic hit, about this. Will do again and try to get the colorado chapter pediatric counsel on board, as well as our congressman.

InsCommissioners.pdf (394.1 KB)

And if you’re wondering who the current Insurance Commissioner is for your state, here’s the directory for them all as of 4/2/20.