AAFP Tells Insurers to Meet Demand for Telehealth Payment

COVID-19 Pandemic Response Requires Expanded Coverage, Says Academy

March 20, 2020 05:15 pm News Staff

To allow family physicians maximum flexibility to meet the demands of the COVID-19 pandemic, the Academy this week asked Congress to require that all health insurance plans expand coverage for virtual care.

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In a March 17 statement,(2 page PDF) the AAFP called for health insurance plans -- including employer-sponsored plans regulated by the Employee Retirement Income Security Act and all Medicaid managed care organizations -- to modify their benefit, coverage and payment policies to increase virtual care options.

Primary care physicians must have expanded latitude to treat patients affected by COVID-19, as well as those seeking routine care while following CDC guidelines for social distancing, the AAFP said.

The Academy advocated four immediate actions:

  • Align telehealth coverage and payment policies with CMS directives for limiting COVID-19 transmission risk.
  • Expand coverage of, and payment for, virtual check-ins and e-visits.
  • Cover telehealth visits at the same payment level as in-person visits.
  • Amend contract language to facilitate virtual care.

"The AAFP calls on all health insurance companies to cover virtual check-ins (HCPCS G2012) and e-visits (CPT 99421-99423 and G2061-G2063), and eliminate patient out-of-pocket costs for such services," the statement said. Payment for these services allows physicians to keep their offices open for care and reduce the risk of transmission by assessing and monitoring patients outside of the office, the AAFP pointed out.

The Academy had already outlined similar priorities in March 11 letters(2 page PDF) to four major U.S. insurers that advocated for strong and transparent virtual care policies.

Carriers, that correspondence said, should "clearly post and communicate what services and diagnostic tests are covered, any cost-sharing that may be waived, and the applicable plan types" so patients do not delay care because of payment concerns.

The AAFP also asked the insurers -- Cigna, UnitedHealth Group, Anthem and Humana -- to eliminate referral and prior authorization requirements for screening and treatment related to COVID-19, hospitalization, post-acute care and home medical equipment, and to waive early medication refill limits on 30-day prescriptions for maintenance medications.

One week later, UnitedHealth Group announced(newsroom.uhc.com) that, for the next 90 days, "all eligible in-network medical providers who have the ability and want to connect with their patients through synchronous virtual care (live video-conferencing) can do so" with waived member cost-sharing for COVID-19 related visits.

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