December 22, 2020
Blue Cross and Blue Shield of Illinois (BCBSIL), in response to the COVID-19 crisis, launched an expanded telehealth program to provide greater access to medical services for our members. Effective March 19, 2020, BCBSIL began providing benefits to fully-insured members for medically necessary covered services provided by in-network and out-of-network providers consistent with the terms of the member’s benefit plan. This aligns with Governor Pritzker’s Executive Order on Telehealth issued on March 19, 2020 as extended in conjunction with the State Disaster Order.
Our Commitment to Telehealth
Moving forward, BCBSIL supports telehealth as an emerging and valuable mode of health care delivery that can help improve the health of our members when appropriate. Telehealth can conveniently give patients access to a wide range of provider services including one-on-one consultations with primary care physicians, mental health services, and remote triage of conditions. We expect and support that telehealth will remain an integral part of the health care landscape in Illinois beyond the COVID-19 pandemic.
During the COVID-19 Pandemic
As we continue under the national public health emergency order, as well as the Illinois state disaster order, telehealth benefits will continue in 2021 for members participating in commercial fully-insured PPO, Blue Choice PPOSM and HMO plans receiving medically necessary covered services provided by in-network or out-of-network providers. Providers of telehealth may include, but are not necessarily limited to, physicians, physician assistants, Advanced Practice Registered Nurse (APRN), licensed behavioral health, applied behavioral analysis, physical therapy, occupational therapy, and speech therapy service providers, as well as nutritionists and dieticians. The cost-sharing waiver for fully insured in-network telehealth continues in accordance with Governor Pritzker’s Telehealth Executive Order and Illinois Department of Insurance guidance.
Additionally, telehealth benefits will continue in 2021 for Blue Cross Community Health PlansSM (BCCHPSM) members receiving medically necessary covered services for telehealth, virtual check-ins and portal visits with Medicaid participating healthcare providers. Cost-share waivers for BCCHP telehealth continue as required by Governor Pritzker’s Telehealth Executive Order and the Illinois Department of Healthcare and Family Services (HFS).
Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Blue Cross Medicare AdvantageSM (PPO and HMO) telehealth benefits will continue in 2021 in accordance with Centers for Medicare & Medicaid Services (CMS) guidance and cost share waivers for telehealth benefits will continue through the end of the public health emergency.
Note: Some self-insured plan members may be responsible for copays, coinsurance or deductibles, based on their employee benefit plan and their employer’s telehealth coverage choices.
Future of Telehealth Post COVID-19 Pandemic
Telehealth, as a mode of health care delivery and its adoption by patients is still new. Best practices, lessons learned, and opportunities for improvement will reveal themselves as more data is collected, outcomes are analyzed, and longer-term effects are observed. Collaboration will allow BCBSIL, working with you, our providers, to develop a more sustainable approach going forward with a targeted focus on quality and appropriateness.
Advance notice of applicable fee schedule or coding changes related to telehealth benefits are typically communicated 90 days in advance on the News and Updates page or through the Blue Review newsletter.
To check telehealth eligibility and benefits for a member, please call our Provider Telecommunications Center (PTC) at 800-972-8088 to request office visit benefits and speak with an agent for telehealth-specific information.
Continue to visit the News and Updates page on the provider website and the Blue Review newsletter for further updates regarding telehealth, member cost sharing and additional responses to COVID-19.