|Wellmark Blue Cross and Blue Shield announced late Thursday that it will temporarily reimburse health care providers that provide services through telehealth — including mental health counselors — at the same rate as office visits.|
The Des Moines-based health insurance company has for a number of years been reimbursing providers for telehealth behavioral services at 75% of the office rate reimbursement for behavioral visits. Medical (non-mental health) telehealth visits are normally reimbursed at 50% of the office rate.
Additionally, Wellmark will allow policyholders who are suffering economic disruption at least 60 days to make premium payments.
The move to temporarily allow equal reimbursement for telehealth visits for the next 90 days is a particularly welcome one for counselors like Jill Lehmann-Bauer, who say the lower rate was unfair to her and other counselors who now must see patients on a virtual basis during the coronavirus crisis.
On Tuesday the Des Moines Register reported on the efforts by Lehmann-Bauer, a Clive mental health counselor, to get Wellmark to change its policy and reimburse fully for virtual visits.
Lehmann-Bauer said in an emailed comment this morning: “We are somewhat confident that Wellmark has set fair standards during a time of pandemic and are still in the process of determining potential barriers in the language we, as a clinical community, are [discussing] from their bulletin.”
She added: “I appreciate the legislators, grassroots efforts of family, friends, advocacy of clients, journalists, and our professional lobbying associations for helping assist us in changing the hearts and minds of the Wellmark initial decisions.
“I am hoping they can lead us to change coverage issues across a broader scale for other Iowans carrying Blue Cross and Blue Shield as a next step. My goal is to get all citizens covered fairly and without bureaucracy. I thank Wellmark for making the concessions and adaptions that were necessary,”.
Michele Keenan, director of NAMI-Greater Des Moines, in an interview earlier Thursday before Wellmark’s announcement, said the lower reimbursement rate for mental health services via telehealth has been problematic.
“A lot of people are struggling with stress, anxiety, and fear right now — including people who have never experienced mental health symptoms before,” she said. “I anticipate that the need for mental health care will increase significantly in the foreseeable future, and reimbursing mental health services provided via telehealth technology at even lower rates only exacerbates the problem.”
The new policy is an addition to several other temporary emergency measures that Wellmark announced on Monday, in which it began allowing for virtual visits with no required cost-share payment from its members.
In addition to temporarily waiving a cost share on virtual health care visits for all appropriate medical and behavioral health visits, Wellmark also said in its earlier announcement Monday it would cover the cost of diagnostic tests for COVID-19, allow early refills of prescriptions, and provide access to 24-hour consultation with a real person with its BeWell 24/7 service.
Two new provisions that were added include:
– Working with individuals and small businesses suffering economic disruption. Wellmark will allow its individual and small business policyholders at least 60 days to make premium payments in order to maintain their coverage.
– Reimbursing providers for virtual visits. Wellmark’s Iowa and South Dakota network providers will receive the same fee for virtual visits as an in-person visit. These changes apply to all appropriate medical and behavioral health virtual visits with any Wellmark in-network provider.
|“We want to support those Iowa and South Dakota providers who are able to offer virtual visit services and encourage people to stay home to avoid the potential spread of the coronavirus,” Cory Harris, Wellmark’s president and chief operating officer, said in a prepared statement.|
“We believe these decisions to be in the best interest of our members, health care providers and the communities we serve. In this time of need we want to provide our members with the most options for care and provide our network with appropriate compensation to effectively deliver that care.”
Wellmark will consider extending these measures as the pandemic situation evolves, Harris said.
Other health insurers have taken similar steps. On Thursday, UnitedHealthcare announced to its members that it would begin temporarily offering telehealth visits at no cost to its policyholders, as well as free access to COVID-19 testing and other expanded benefits. It’s not immediately clear whether its provider reimbursements will be made at 100% of the office rate. The Center for Medicare and Medicaid Services also this week lifted restrictions that had been in place to allow telehealth visits to be reimbursed by Medicare.
In a phone interview with the Business Record, Harris said that Wellmark had been working “on a dual track” along with cost-share waiver to enable equal reimbursements to providers for virtual visits, but first had to take steps to assess what medical providers were able to accommodate.
Harris said that “in a perfect world” he would have preferred launching the equal reimbursements for virtual visits at the same as the other policies, but that four days was as fast as the company was able to accomplish it.
Wellmark, which is the leading health insurer in Iowa, anticipates a significant surge in telehealth visits while people are asked to shelter in place during the coronavirus pandemic. Until this point, telemedicine visits have had very low usage, he said.
“Our hope by moving to telephone and not having to use a particular platform will ameliorate that,” he said. “We have tried to be as broad as we can be in what we allow.”