If you think you may have symptoms of COVID-19, it’s important to speak with a doctor who will be able to advise you whether you should get tested. Given how contagious coronavirus is, telemedicine has become the new norm for healthcare visits. It’s important to be aware that the rules regarding telehealth and coronavirus-related medical treatment are continuing to evolve– although it may appear that coronavirus-related healthcare is fully covered by insurance, there are a few assumptions you should avoid making.

  1. Don’t Assume Your COVID-19 Related Telemedicine Visit is Covered by Insurance

Due to COVID-19, telemedicine is used more than ever. Although Medicare used to allow coverage of telemedicine visits only if the recipient lived in a remote area, these requirements have been relaxed. If you are of Medicare age, you shouldn’t have to pay anything for a telemedicine visit other than the standard 20% coinsurance for which you’ve always been responsible. In many cases, this can be covered by secondary insurance.

If you have a commercial policy, each company is handling telemedicine visits differently. This means you can’t assume that your telemedicine visit will be covered. However, most insurance companies are waiving cost-sharing and paying the full cost of the visit. In cases where medical insurance does not cover telemedicine, the doctor can determine their own rates for these non-covered services.

  1. Don’t Assume a Telemedicine Visit NOT Related to COVID-19 is Covered

Since COVID-19 is highly contagious, many doctors are also urging patients to utilize telemedicine for any and all health issues whether or not they are related to COVID-19. Telemedicine visits reduce the risk of being exposed to the virus or exposing others during an office visit.

If you are on Medicare, the costs of a telemedicine visit not related to COVID-19 are covered. However, each commercial insurance company is considering telemedicine differently for these types of visits – some companies may apply the cost to your deductible if it hasn’t been met yet. Others are waiving cost-sharing for the next ninety days pending the status of the pandemic.

  1. Don’t Assume Your Bill is Incorrect If You are Charged a Co-Pay

If you’ve been charged a co-pay for a COVID-19 related telemedicine visit, your bill may or may not be correct, depending on your plan. First, contact the insurance company to find out what your specific plan covers and whether there is cost-sharing you are required to pay. If not, ask your insurance company why they did not pay the claim in full. Depending on their answer, you may need to reach out to your provider to have them correct or resubmit the claim, or request that the insurance company reprocess the claim to reflect the appropriate payment.

  1. Don’t Assume Telehealth is Covered Under an Employer-Funded Healthcare Plan

Although most insurance companies are waiving cost-sharing for their fully-insured plans, this may not be the case if your plan is self-funded. If your employer funds the healthcare plan, the same governmental regulations do not apply. Rather, the employer decides how claims will be processed and whether telemedicine is covered at all, with or without cost-sharing.

How Systemedic Can Help With Your COVID-19 Medical Bill Dispute

Disputing a COVID-19 medical bill can be a complex process. Systemedic has been in the medical billing business for over 30 years and knows what it takes to dispute even the most complicated medical bills quickly and effectively.

Offering a fee-based service for those looking to dispute their medical bills, our medical bill dispute advocates are skilled in navigating the insurance maze and will not take “no” for an answer.  To get started with resolving your medical bill dispute, contact us for a consultation.