We cover medically necessary services conducted via telehealth for suitable medical and mental health services, including select dental services covered under the medical plan. Providers must be able to deliver virtual care using their own HIPAA-compliant platforms.
Please be sure to check each member’s benefits and eligibility before rendering services.
| For | Telehealth is |
|---|---|
|
Commercial plans (EPO, HMO, Indemnity, POS, PPO) Medex ®’ |
A site of care. Members can obtain telehealth services from any Blue Cross medical provider who offers it. |
| Federal Employee Program (FEP) plans |
A site of care.
The term "telehealth" is used interchangeably with "telemedicine" for FEP members. Therefore, it’s important to refer to fepblue.org for guidelines on benefit coverage for services covered by Teladoc or telemedicine/telehealth services covered by Blue Cross providers.
Important to note: FEP members are not covered for preventive care services via telemedicine; however, some services are offered via Teladoc. |
| Medicare Advantage plans | Covered for select telehealth services. |
Refer to our payment policies for guidance on telehealth coverage.
- Telehealth – Medical payment policy
- Telehealth – Mental health payment policy
To download our payment policies, log in and click Find a Payment Policy on the right side of your home page. Or, go to Office Resources>Policies & Guidelines>Payment Policies.
All covered medical and mental health services that are suitable for telehealth are listed in the applicable payment policy. Please note:
- Telehealth is considered a site of care.
- A member may choose to receive in-person care rather than telehealth if they wish.
- See our telehealth payment policies for reimbursement information.
- There isn’t a special credentialing process to become a covered telehealth provider with Blue Cross Blue Shield of Massachusetts. You may be reimbursed for covered plan services via telehealth if you have the ability to offer secure, HIPAA-compliant video visits in accordance with all federal and state laws, and are currently credentialed by Blue Cross Blue Shield of Massachusetts.
- We encourage you to notify us that you offer telehealth, so we can add it to your listing in our Find a Doctor & Estimate Costs directory.
In addition to Blue Cross providers, some of your patients may use Well Connection, powered by Amwell’s national network.
- All fully insured members have access to Well Connection (except Medicare Advantage, Medex®’, and FEP members).
- Some members may have Well Connection as an optional expanded network solution if their employer is self-insured.
- Well Connection offers mental health therapy and psychiatry by appointment, and urgent care medical visits in all 50 states 24/7, 365 days a year.
- Referrals are not required.
In addition to receiving certain telehealth services from Blue Cross providers, FEP members may use Teladoc®′ Health.
- Visits are covered at no additional cost.
- Coverage includes:
- Treatment for minor injuries, illnesses, and non-emergency health issues
- Mental health care
- Dermatology
- Nutritional counseling
Additional guidelines are available on fepblue.org.
Please consult the local Blue Cross plan that you are contracted with. They have their own payment policy for telehealth services. Blue Cross Blue Shield of Massachusetts will reimburse telehealth covered claims that we receive through the BlueCard® program.
There are no age limits for members who need care through telehealth or telephone services.
Standard member cost (copayment, co-insurance, deductible) will apply, and is typically equal to the in-person cost for the service. It’s important to always verify the member’s cost before collecting payment at the visit, because:
- Cost variations may apply.
- Both fully and self-insured accounts have the option to lower the telehealth cost via rider if they choose.
Note: The same referral and authorization requirements apply for telehealth visits as in-person visits. Telehealth is a site of service, so the referral and authorization guidelines are driven by the service being rendered, not the telehealth site.
For example: if a member typically needs a PCP referral to see a specialist, the referral is required for both in-person and telehealth specialist visits.
