To Our Valued Clients:
We recognize that there is plenty of uncertainty right now unfolding around the situation we find ourselves in with the introduction of COVID-19. At Diversified, our aim is to add some clarity surrounding your medical plan by reviewing the trending topics of the calls coming into our member services department.
Question #1: Does my plan cover telemedicine?
There has been a lot of talk around telemedicine recently with the COVID-19 virus limiting access to
primary care for many people. Diversified is currently receiving a large volume of calls to our member services
area on this particular topic.
Virtual Office Visits Under the Medical Plan
Some physicians, particularly now, offer virtual office visits (via phone or online). For example, with COVID-19 concerns, many mental health providers are canceling face to face sessions with their current patients in lieu of a virtual office visit.
If your employee’s provider entertains virtual care, when a member seeks care from that primary care doctor, specialist or mental health provider and the visit is conducted on the phone or online, the doctor will still bill the plan for the virtual visit as if the member had gone to the office. The plan will pay according to the plan’s covered benefit design (including all applicable cost shares – deductible, copays, coinsurance). Coverage level may depend on whether the doctor is in or out-of-network. Additionally, many hospitals provide e-visits for minor medical concerns via a web portal. When this visit is billed, it will be paid according to the plan’s benefit level for in or out-of-network facilities. Members should check with their physician’s office to see if they extend virtual visits or check any facility’s website for information on virtual visits (however, please be sure to check whether the facility is in or out-of-network).
Keep in mind that this benefit does not negate the value of a standalone telemedicine program (see below). If you already offer one, your members have access to care 24/7 at a low or no copay and the charge to the plan is at a much reduced rate than a typical in person or virtual physician visit.
Standalone Telemedicine Program
A standalone telemedicine plan (ie., Teladoc or Call A Doctor Plus) typically charges a fairly reasonable per employee per month (PEPM) fee and a low or no copay per visit for members who access care. They are designed to drive plan cost savings when utilized efficiently and effectively. Charges to the plan are much lower than the standard office visit charge. They can be added on top of the health plan and are administered by a third party vendor. These plans are a great option, particularly in these trying times for non COVID-19 related illness that may occur. A standalone telemedicine solution steers enrolled members to a board certified physician that participates with the telemed firm but not their own doctor with whom they may have a relationship.
Please feel free to contact your Diversified Sales Team or Account Executive with any questions at (888) 322-2524.
Working for you: Diversified Group has plans and resources in place in our effort to protect our employees and continue to serve our clients. We have a business continuity plan to deal with any business disruption due to unforeseen circumstance. Our staff is prepared to handle a potentially large number of claims for members who may become ill and our systems are equipped to allow for telecommuting without service disruption.
COVID-19 Summary: For the most updated information about COVID-19, visit the CDC’s page at https://www.cdc.gov/coronavirus/2019-ncov/index.html or the World Health Organization at https://www.who.int/emergencies/diseases/novel-coronavirus-2019
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