The current COVID-19 outbreak and the use of social distancing in responding to it have produced an immediate need for Arkansas Blue Cross and Blue Shield and Health Advantage to give fully insured members expanded health insurance benefits to promote greater access to remotely delivered services – including greatly expanded insurance benefits to help them deal with emotional/behavioral issues the outbreak may create or compound.
Accordingly, Arkansas Blue Cross and Health Advantage are encouraging fully insured members and healthcare providers to use audio-visual and telephone technology for certain services related to physical and/or behavioral health, in lieu of an in-person visit, where appropriate in the provider’s professional judgment. During this time, Arkansas Blue Cross and Health Advantage also are waiving costs their fully insured members normally would have to pay for such services, when received from an in-network provider. These temporary changes will be in effect through at least May 15, 2020, and could be extended after that, if circumstances warrant.
“We are encouraging people to use technology, as advised and assisted by their health care provider, to get the care they need and also use the medically smart practice of social distancing,” said Mark T. Jansen, M.D., vice president and chief medical officer for Arkansas Blue Cross. “A provider may be able to help a member in their home, through a video chat or just a simple phone call. During this current public health emergency, we have temporarily waived all out-of-pocket costs for these services. It’s an option that may be easier and safer for members and their providers. Out-of-pocket costs for in-person coronavirus testing have been waived, as well, so members can get the care they need and do their part to help curb the spread of coronavirus at the same time.”
And while social distancing is a weapon in the battle against coronavirus, Arkansas Blue Cross and Health Advantage recognize that it can also affect the peace of mind of members.
“Concern for our health and that of our loved ones. Closings of schools and businesses. Cancellations of church activities, sporting events and gatherings. Added economic worries. These things are all products of the coronavirus outbreak, and they each can take a toll on our emotional well-being and mental state,” said Curtis Barnett, Arkansas Blue Cross president and chief executive officer. “Mental health is vitally important, and we want our members’ insurance benefits to make it easier, in this critical period, for them to gain access to professional help if they need it.”
Arkansas Blue Cross and Health Advantage fully insured members have access to an in-network, statewide panel of almost 2,300 behavioral health professionals already credentialed and ready to serve their emotional/mental health needs.
Please note: Any changes or enhancements to the benefits available to self-funded members served by BlueAdvantage Administrators of Arkansas or by Health Advantage (such as state and public school employees) are up to the employers or plan sponsors who fund those self-funded programs.
In addition, the specific conditions under which Arkansas Blue Cross and Health Advantage will implement and pay these temporary, enhanced benefits during the coronavirus crisis are spelled out in more detail on their respective websites and the last page of this press release.
Specifics of the expansion of services, through at least May 15, 2020, include:
- Telephone–based doctor’s visits – Arkansas Blue Cross and Health Advantage will provide payment for any in-network physician (M.D. or D.O) to visit by telephone with patients who are seeking advice or counsel on either physical or mental health needs. In addition to creating this entirely new, temporary benefit for our fully insured members, Arkansas Blue Cross and Health Advantage will also waive all copays, coinsurance and deductibles for these new telephone-based benefits.
- Telephone-based behavioral/mental health visits – We are also extending this same new, temporary insurance benefit for telephonic counseling by in-network behavioral health professionals. Specifically, Arkansas Blue Cross and Health Advantage will pay for telephone-based counseling to our fully insured members by any in-network psychiatrist, psychologist, advance practice nurse practitioner, licensed clinical social worker or licensed professional counselor. As with telephone-delivered physician services, copays, coinsurance and deductibles will be temporarily waived.
- Temporary waiver of copays, coinsurance and deductibles for telemedicine (seeing a doctor, nurse practitioner or physician assistant via an interactive audio-visual communication system): The new, temporary insurance benefits outlined above are in addition to the normal telemedicine benefits that Arkansas Blue Cross and Health Advantage fully insured members already have and which they can continue to utilize. However, we are also waiving copays, coinsurance and deductibles for all telemedicine services to fully insured members.
Temporary Insurance Benefit Policy Details
Effective March 16, all Arkansas Blue Cross and Health Advantage insured members will have the following new, temporary insurance benefits available for both physical health needs and any behavioral/mental health counseling needs:
- Telephone-based doctor’s visits. Our existing exclusion of insurance benefits for telephone-based services is being suspended from now through at least May 15, 2020 to provide payment for any in-network physician (M.D. or D.O.) visit by telephone, for purposes of receiving advice or counsel on either physical or mental health needs. Physicians will receive instructions on how to file insurance claims for these services using new, special codes designated exclusively for telephonic services. In addition to creating this entirely new, temporary benefit for our fully-insured members, Arkansas Blue Cross will also waive (through at least May 15, 2020) all copays, coinsurance and deductibles for these new telephonic benefits.
- Telephone-based behavioral/mental health visits. We are also extending this same new, temporary insurance benefit for telephonic counseling by in-network behavioral health professionals, not just physicians. Specifically, from March 16, 2020 through at least May 15, 2020, Arkansas Blue Cross and Health Advantage will pay for telephone-based counseling to our fully insured members by any in-network psychiatrist, psychologist, advance practice nurse practitioner, licensed clinical social worker or licensed professional counselor. As with physician claims, copays, coinsurance and deductible will be waived for these new telephonic service benefits, through at least May 15, 2020.
- Temporary waiver of copays, coinsurance and deductibles for telemedicine. The new, temporary insurance benefits outlined above are in addition to the normal telemedicine (interactive audio-visual contact) benefits that Arkansas Blue Cross and Health Advantage fully insured members already have and which they can continue to utilize. However, Arkansas Blue Cross and Health Advantage are also waiving copays, coinsurance and deductibles for all telemedicine services to its fully insured members through at least May 15, 2020.
PLEASE NOTE: These new, temporary insurance benefits and the applicable procedures and limitations, are outlined below:
TERMS AND CONDITIONS APPLICABLE TO NEW, TEMPORARY TELEPHONIC SERVICES BENEFITS
- Please note that telephone counseling is ordinarily not a covered benefit under any Arkansas Blue Cross and Blue Shield and Health Advantage insurance policy/benefit certificate. Accordingly, these expanded benefits are by special exception only, including all conditions outlined below.
- In order to be covered, all telephonic consultation by physicians, advance practice nurse practitioners, licensed clinical social workers, licensed professional counselors or psychologists (“Telephonic Providers”) must be submitted electronically to Arkansas Blue Cross and Blue Shield in accordance with the standard, established claims-filing policies and procedures required for other electronic claims. This includes but is not limited to timely claims filing requirements.
- All claims for telephonic consultation by Telephonic Providers must be submitted with one of the following CPT codes, as applicable:
Telephone Evaluation/Management (E/M) Services
99441 Telephone; 5-10 minutes $16.38
Description: Telephone evaluation and management service by a physician or other qualified healthcare professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
99442 Telephone; 11-20 minutes $32.61
Description: Telephone evaluation and management service by a physician or other qualified healthcare professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.
99443 Telephone; 21-30 minutes $48.74
Description: Telephone evaluation and management service by a physician or other qualified healthcare professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion.
- NO claims for any telephonic services other than the three CPT Codes listed above will be accepted, covered or paid by Arkansas Blue Cross and Health Advantage.
- Normal copays, coinsurance and deductible, as specified in a member’s applicable insurance policy/benefit certificate, will be waived for all Telephonic Provider telephone consultations billed in accordance with these provisions.
- Payment for all Telephonic Provider services shall be strictly limited to the Allowances (dollar amounts) set forth above with respect to each CPT Code.
- All claims for Telephonic Provider services will continue to be subject to all terms, conditions, limitations and exclusions of each member’s insurance policy/benefit certificate, except for the following provisions of such policies/certificates which are temporarily waived through May 15, 2020: (i) exclusion for “Telephone and Other Electronic Consultation”; and (ii) copay, coinsurance and deductible provisions.
- All coverage for Telephonic Provider services, as described in this announcement, will end at midnight on May 15, 2020, unless Arkansas Blue Cross and Health Advantage decide to extend this special benefits extension for COVID-19 telephone counseling beyond that date; we will reassess the situation at that time and, if special benefits are extended, will make another public announcement. If no such extension announcement is made, any claims for Telephonic Provider services submitted for dates of service after May 15, 2020 will be denied, in accordance with standard provisions of applicable insurance policies/benefit certificates.
- All claims for payment of Telephonic Provider services are subject to the standard terms and conditions of each Telephonic Provider’s network participation agreement with Arkansas Blue Cross and Health Advantage.
- Unless services are not available from an in-network provider or constitute emergency care that could not be obtained from an in-network provider, no coverage or payment will be extended for telephone services/telephone consultation of any out-of-network provider because this is a limited-duration exception to normal policy/benefit certificate exclusions made in consideration of a public health crisis, and it is not feasible to conduct the necessary credentialing review and computer systems adjustments necessary for including non-participating providers in a temporary benefit that will end on May 15, 2020.
- This announcement does NOT apply to any self-funded health plan members served by our BlueAdvantage Administrators of Arkansas division. Any decision regarding coverage for COVID-19 telephone consultation services for such self-funded members belongs exclusively to the employer and/or Plan Administrator of each applicable self-funded health plan.
