How Private Insurers Have Dragged Their Feet On A Crucial COVID-19 Safeguard

Amid concerns that their policies were getting in the way of a key COVID-19 safeguard, several private insurance plans have backed down from limitations they’d placed on access to telehealth.

The reversal comes weeks after COVID-19 started spreading through the United States and public health officials began urging Americans to avoid unnecessary in-person interactions, including interactions with the primary care doctors they see for routine care or minor medical issues.

Instead, patients are being urged to use telehealth — i.e. consultations conducted through electronic communications platforms — and other forms of remote care when possible.

While the move is necessary to prevent the spread of the coronavirus, the expansion of telehealth has presented an assortment of operational and financial challenges to private care doctors, as TPM reported last week.

Among them is the confusion about what private insurance plans would cover. Some insurers have been slow to follow the example set by the Trump administration, which took steps earlier this month to expand coverage of virtual care options for patients on Medicare, Medicaid and other federal programs.

Until last week, several private health care plans were only covering telehealth visits if a patient’s doctor was using an approved telemedicine platform.

Some insurers had publicly touted that they were waiving cost-sharing requirements when patients used telehealth to seek treatment of COVID-19 or suspected COVID-19 treatments.

But what those announcements left out was that many of these plans, as of a week ago, were not covering at all certain telehealth visits, if the appointment was for an issue not related to COVID-19 and the doctor was not using the plan’s specific telemedicine platform.

One such plan was Blue Cross Blue Shield’s plan for federal employees (known as FEP). Prior to last week, the plan only covered non-COVID19 telehealth visits if the doctor was using a platform called Teladoc.

This meant that if a patient’s doctor was not on Teladoc, and the patient was seeking virtual treatment for a non-COVID19 issue, the patient would need to either pay for the visit himself, convince his doctor to sign up for Teladoc or find another provider who was using the platform.

Blue Cross Blue Shield changed that policy, and issued guidance announcing the change on March 24, a BCBS spokesperson told TPM Monday.

Nonetheless, the old policy prompted confusion and frustration among patients and providers alike, with several people taking to Twitter to complain about the obstacles they were facing in accessing telehealth services.

None of my family’s providers use this system and being able to check in with doctors and therapists during a socially isolating pandemic seems like a good idea.

— Matt Separa (@MattSepara) March 27, 2020

Gene Ransom, the CEO of The Maryland State Medical Society, told TPM Friday night that members of his association had raised concerns about the roadblocks that had previously been in place.

“It really disrupts the physician-patient relationship,” Ransom said, while confirming his group had learned that the policy had been changed.

“We are in the middle of a crisis. It’s really unfair to treat these federal employees differently from other patients,” Ransom said.

One FEP member — who asked to remain anonymous, for fears publicizing the issue could cost her her employment — told TPM it took her two weeks to get BCBS to come around on covering her non-Teladoc telehealth visit.

The member first reached out to BCBS on March 17 about getting a telehealth visit covered for a doctor who wasn’t on Teladoc. About a week later, she was told again BCBS-FEP was sticking to its policy of not covering non-Teladoc telehealth visits.

The member reached out to both her congressperson and the federal government’s Office of Personnel Management for their help with getting her appointment covered. Only on Monday did BCBS confirm to the member that it would in fact cover non-Teladoc telehealth visits, subject to the usual cost-sharing requirements.

A provider association based in Michigan told TPM that the guidance it received from BCBS-FEP on Friday suggested that the old policy was still in place.

The BCBS website for its North Carolina plans was updated on March 26 to reflect the new policy, and a BCBS spokesperson said the March 24 guidance may “take some time to implement.”

Anthem meanwhile announced on Thursday that its plans in Virginia and Georgia were now covering and waiving cost-sharing for telemedicine treatments that were sought using platforms besides LiveHealth Online, the service it typically designates for telehealth coverage.

According to Shawn Martin, a top executive at the American Academy of Family Physicians, restricting telehealth medicine coverage to specific technology medicine platforms is a tactic used by insurers even before the pandemic.

While providers have opposed the limitations before the outbreak, their concerns have been exacerbated by the major increase in telehealth usage the pandemic has necessitated.

“We have been making a ton of noise,” Martin said, adding that the insurance plans have often changed their tunes once they were called out for the restrictive policies.

“It’s a game of whack-a-mole now,” Martin said.