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Telehealth

We cover medically necessary services conducted via telehealth for suitable medical and mental health services, including select dental services covered under the medical plan. Because we consider telehealth a site of care for commercial (EPO, HMO, Indemnity, POS, PPO), Medex®’, and Federal Employee Program (FEP) plans, these members can obtain telehealth services from any Blue Cross medical provider who offers it. Providers must be able to deliver virtual care using their own HIPAA-compliant platforms.

Our Medicare Advantage plans offer coverage on select telehealth services. Please be sure to check each member’s benefits and eligibility prior to rendering services. And for additional guidelines on FEP members, visit fepblue.org.

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Payment information

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.

Covered services

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.
Provider eligibility
  • 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 directory.
Telehealth offered via Well Connection

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.
Out-of-state provider billing

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.

Member age

There are no age limits for members who need care through telehealth or telephone services.

Member cost

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.

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