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.
Refer to our payment policies for guidance on telehealth coverage.
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:
In addition to Blue Cross providers, some of your patients may use Well Connection, powered by Amwell’s national network.
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:
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.