Confused about insurance carrier cost-sharing waivers and coverage expansion?

May 11, 2020

Health plans across the country have been updating their coverage and cost-sharing requirements at a rapid pace, and it has been a challenge for allergy practices to keep up with the changes. The College wants to provide some resources to help. The following third-party resources have information on the status of various insurance plans, including telemedicine coverage and cost-sharing waivers, where available.

While these are helpful resources, we strongly encourage you to verify the information with your local payers, as policies can vary locally and are changing rapidly. The College cannot endorse the information provided in these resources.

National and State Telemedicine Billing Guidelines by Payer – A billing company has put together a helpful list of telemedicine covered services, cost sharing, place of service (POS) and modifier requirements for state and national carriers on a Google worksheet, which is being updated regularly. We recommend you review the source documents provided in the link for each plan to verify accuracy.

Health Insurance Plans’ Response to COVID-19 – America’s Health Insurance Plans (AHIP) provides a summary of expanded coverage and cost-sharing waivers by carrier.

MGMA Commercial Health Plan COVID-19 Policies – This resource outlines the COVID-19 policies of major national health payors as of May 11, 2020. It will be updated regularly.

Medicare Flexibilities Related to COVID-19 for Physicians and Providers – This fact sheet from the Centers for Medicare and Medicaid Services provides a summary of the flexibilities provided for physicians and providers due to COVID-19.

In addition to these resources, the College was recently advised that UnitedHealthcare is waiving cost sharing (copays, coinsurance and deductibles) for UnitedHealthcare Medicare Advantage plan members for all covered office-based professional services  from May 11, 2020 until at least Sept. 30, 2020. Plus, TRICARE is updating its telehealth requirements to expand the availability of audio-only telehealth services. We encourage you to confirm these changes with your local carrier.

Stay tuned to College Insider for further updates on insurance coverage and other billing and coding issues!