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Two COVID-19 updates effective July 1, 2021: Change to telehealth cost share and authorization requirements
May 20, 2021

This article is for all providers (except dentists) caring for our members

In March of 2020, we announced that we were temporarily waiving member cost share (copayment, co-insurance, and deductible) for both non-COVID and COVID telehealth visits to help ensure our members had access to health care services. We also temporarily waived authorization requirements. As vaccines roll out and states and businesses reopen, we want to share two important updates.

 Member cost share reinstated for non-COVID telehealth services

Effective July 1, 2021, we will reinstate member copayments, co-insurance, and deductibles for non-COVID telehealth visits, including all mental and behavioral health services.

Note: These changes do not apply to our Medicare Advantage members. We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. For more details, please see fepblue.org.

Please bill members for their cost share once the claim has processed
When you are checking eligibility, Online Services will show the standard telehealth cost share. The system will not distinguish between a COVID visit and a non-COVID visit; therefore, we recommend that you bill the member for the applicable cost share once the claim has processed to ensure you do not have to reimburse the member.

 Resuming authorization processes

In alignment with guidance from the Division of Insurance, we have resumed the normal authorization processes for all services for our commercial and Federal Employee Program members, and will start requiring authorization for Medicare Advantage members on July 1, 2021.  

We will continue to waive the authorization requirement for commercial and Medicare Advantage initial requests for the following services with a COVID diagnosis:

  • Emergent inpatient services
  • Skilled nursing, rehab, and long-term acute care
  • Home health care

If you aren’t already, please submit clinical information for all authorization requests with the exceptions noted above. The authorization process will officially resume for all products effective July 1, 2021.

As always, thank you for the care you provide to your patients—our members.